HV 3006 
.03 N3 
Copy 2 



Report of 
ental Hygiene Survey 
of Cincinnati 



CONDUCTED BY 



The National Committee for Mental Hygiene 



NEW YORK CITY 

V. V. ANDERSON, M. D. 
Associate Medical Director 



TSI'ICES OF THE 

MENTAL HYGIENE COUNCIL 

OF THE 

PUBLIC HEALTH FEDERATION 

.INXATI 



'$& 



MAY, 192^ 




Class. H V 3-dJl£- 
Book. Q a Na_ 






6% 

Report of the Mental Hygiene 
Survey of Cincinnati 



CONDUCTED BY 



The National Committee for Mental Hygiene 



Published by 

The Mental Hygiene Council 

of the 
Public Health Federation 

25 East Ninth St. 
Cincinnati, Ohio. 

May, 1922 



PART I. — The Mental Hygiene Survey 
and Recommendations. 

PART II. — A Study of the Feebleminded 

AND 

A State Mental Hygiene 
Program. 

^4u o 



H\Jsooy 
.O3N3 

Copy Zi 



SURVEY STAFF 

V. V. Anderson, M. D Director of Survey 

Christine M. Leonard, M. D Psychiatrist 

Rose Dintzess, M. D Psychiatrist 

Frank S. Fearing Psychologist 

Bertha M. Allen Psychologist 

Mrs. Flora M. Fearing Psychiatric Social Worker 

Mary B. Laughead Psychiatric Social Worker 

Marguerite Reid Social_ Worker 

Mrs. Janet Lauer Volunteer Worker 

Elizabeth Schmidt Social Worker 

W. Margaret Cavender Secretary 

Emily Drier Volunteer Worker 

There were many others who gave a certain amount of time and assistance 
in connection with the survey. 



liBRARY OF CONGRESS 

^SCSIVEP 

JAN 31 19*3 

DOCUMENTS* «.> V i 3*0 



fr 



• Letter* of Transmittal 

March 31, 1922 
^To the Public Health Federation: 

Your Mental Hygiene Council became convinced that in order to formulate 
a satisfactory program for meeting the mental hygiene problem in Hamilton 
County it was absolutely essential that we have before us the accurate facts as 
to just what the problem is with which we are trying to deal. We felt that, 
there was no better way of getting this information than through a compre-i 
hensive survey by the National Committee for Mental Hygiene if we should be 
fortunate enough to secure the consent of the National Committee to come here 
to make such a study. 

Accordingly a formal request, officially approved by the Public Health 
Federation, was made to the National Committee, the consent of the different 
agencies and institutions which might be included in the survey was secured 
and this petition submitted on January 7, 1921. We were deeply pleased when 
the Committee agreed to come here to make the survey. 

The National Committee began its work in March, 1921. It is unnecessary 
to state how broad the survey was in its scope because that is amply included 
in the pages of the report itself. We feel that this has been one of the most 
comprehensive surveys of mental hygiene made in any city of the country, that 
it has been a contribution worth thousands of dollars to this community. We 
believe that Cincinnati and Hamilton County owe a deep debt of gratitude to, 
the National Committee and to Dr. Anderson and his very competent staff for 
the excellent work they have done here. 

This Council has had presented before it a summary of the findings and 
recommendations from the survey and we beg to state herewith that we are 
heartily in accord with them and that we shall bend every effort to have the 
recommendations of the survey put into effect. 

MENTAL HYGIENE COUNCIL OF THE PUBLIC HEALTH FEDERATION 
Emerson A. North, M. D., Chairman 

Miss Lulu Aler Dr. Wm. S. Keller 

Dr. E. N. Baehr Dr. Charles E. Kiely 

Miss Alma Baumgartner Miss Emma Kohnky 

Dr. Julien E. Benjamin Mrs. Simon Kuhn 

Mrs. Rebecca Boyl Dr. Louis Lurie 

Dr. B. B. Breese Dr. Carey P. McCord 

Miss M. Edith Campbell Miss Blanche Pfefferkorn 

Dr. Elizabeth Campbell Dr. Wm. Ravine 

Mr. A. C. Crouse Mrs. Wm. Rosenthal 

Dr. A. W. Foertmeyer Mr. Max Senior 

Dr. E. W. Fell Mr. E. F. Van Buskirk 

Mrs. Martin Fischer Mrs. Murray Seasongood 

Rev. F. A. Gressle Mrs. Ruth I. Workum 

Miss Ethel Goldsmith Mrs. Helen T. Woolley 

Hon. Charles W. Hoffman 

Bleecker Marquette, Secretary 



ACKNOWLEDGEMENTS 

We wish to express our sincere appreciation and great indebtedness to 
the Vocation Bureau, the City Department of Health, the Superintendent of 
Schools and the principals and teachers in the public schools of Cincinnati, 
the staff of the Juvenile Court, the Associated Charities, the Ohio Humane 
Society (who so kindly furnished us with office quarters), the United Jewish 
Social Agencies, the Bureau of Catholic Charities, the Superintendent of 
Longview Hospital, city and county officials having charge of the county 
jail and of the city and county infirmaries, and finally to the members of 
the Mental Hygiene Council of the Public Health Federation and to all who 
have so generously given of their time and advice in the survey. 

We hardly know how to express in a few words our grateful appreciation 
to Mr. Bleecker Marquette, Executive Secretary of the Public Health Federa- 
tion. It will be impossible to give any idea of the immense help he has 
been. It is no exaggeration to say that, without his wise counsel and generous 
and effective assistance, the survey would not have been possible. 

Finally, an expression of gratitude is due to the entire survey staff, for 
their untiring efforts to make this survey a success. The great amount of 
work in number of hours, though they were long and usually included more 
than the working day, in no sense, represents their contribution to this study. 
The enthusiasm they all have felt for their work must have extended itself 
to others and served a great educational purpose for mental hygiene. 

In the preparation of this report, particular mention should be made of 
the great help received from the Statistical Department of the National Commit- 
tee for Mental Hygiene, from Mr. Donald Slesinger of the Division on Mental 
Deficiency, and from Mr. Frank Fearing, Mrs. Flora Mae Fearing, Miss Mar- 
garet Cavender, Dr. Rose Dintzess, and Miss Bertha Allen, of the field survey 
staff. 

V. V. ANDERSON, M. D. 



CONTENTS 



PART I. 



Introduction 
Scope of Survey 
Methods Employed 
Presentation of Data 
Delinquency 

Juvenile Delinquency 
Juvenile Court 
Boys' Opportunity Farm 
Girls' Opportunity Farm 
Adult Delinquency 

Hamilton County Jail 
Ohio Humane Society 
Illigitimacy 
Discussion of Delinquency 
Dependency 

Juvenile Dependency 
Children's Home 
General Protestant Orphanage 
Boarding Home Children 
Adult Dependency 
City Infirmary 
Hamilton County Home 
Associated Charities 
United Jewish Social Agencies 
Bureau of Catholic Charities 
Public School Children 

Mental Conditions Found Among School Children 
Physical Condition of School Children 
The Social Environment of the Problem School Child 
Summary 
Special Classes 

Discussion of Public School Findings 
Conclusions 
Recommendations 



PART II. 

Study of Careers of 322 Feebleminded Persons in Cincin- 
nati — Made Up of Two Groups: 

(1) Two Hundred and One Ex-Students of Special 
Classes for Defectives. 

Institution Cases. 

Individuals Now Gainfully Employed. 

Study of the Homes. 

Contact With Social Agencies 

Summary. 

(2) One Hundred and Twenty-one Mental Defectives. 
(Diagnosed by Vocation Bureau 1917-1919.) 
General Data 

Institutional Cases 
Home Conditions 
Contact with Social Agencies 
Court and Institutional Records 
Summary and Conclusions 
Recommendations for a State Me.ital Hygiene Program. 



Chart Jmowiaig feQueNCY or Mental AbajohmalitiCsT 
Among- Ime Thr.ee Main Grdupj in The. Jur,vcy 



Pu&LlC JCHOCL CHILDKEM 




It m thij jmall group of mentally abnormal 
children who provide the vajt majority op our. 

DELINQUENCY AND DEPENDENCY PP^O&LEMi LATER, IN LIFE. 



D^LlNqUENCY CAJE.J 



Adult Dependency Cajej 




/ \ 8-7 7. J 




3va Formal \ 
11.47. \ 


/NORMAL \ 
1 27j7 ° \ 




^™IE*!5 f *^^l l ^-. J ^M ''77. 


Meatm. Pcfcct ->*"/ 
7-7 7»>^ / 


^^^ t " / «Of M - J 


Psychopathic / 
V 8.17- / 


Mentally / 
Phased /abnormal 
23 % / ^cxtallY 
/ 7Z.1 7. 



A PE.FUTON WHO )J MENTALLY ABNORMAL 1J 
TrtREg. TIMES AJ LIKELY TO BECOME DELINQUENT 
OR. DEPENDENT AJ" A NOR.MAL PEIWON. 



PART I 

GENERAL SUMMARY 



CHE purpose of this survey was to throw light upon the mental factors 
involved in various social problems with which this city has to deal, to 
HH^ determine the frequency of mental disease and feeblemindedness, and 
what bearings these conditions, as well as other mental conditions, had upon 
delinquency, illegitimacy, vagrancy, prostitution, dependency, outdoor relief, 
unemployment, etc. 

Studies were made of individuals coming in contact with the Juvenile 
Court, the Opportunity Farms for Boys and Girls, Hamilton County Jail, the 
Ohio Humane Society, the Associated Charities of Cincinnati, the United 
Jewish Social Agencies, the Bureau of Catholic Charities, the Home for the 
Friendless, the Catherine Booth Home, the Children's Home, the General 
Protestant Orphanage, the boarding homes children, county and city infirm- 
aries, and finally over 4,000 public school children. 

Delinquency 

At the Juvenile Court it was found that approximately two-thirds of the 
children had intelligence quotients over 80 (intellectual retardation was not 
considered an important factor in their delinquent conduci) ; approximately 
two-thirds of the children, when classified from a psychiatric point of view, 
were found to be suffering from either psychopathic personality, epilepsy, 
feeblemindedness, borderline mental defect or mental disease, or were classed 
as subnormal. Approximately 70 per cent of the Juvenile Court cases were 
found to be in homes that received the lowest scores on "Parental control and 
supervision," and "Parental conditions" (these items are explained fully in 
the text). The homes of the delinquent girls were more unfavorable than 
those of the boys. Ninety per cent of the delinquent girls came from homes 
that received the very lowest scores possible on "Parental conditions" and "Par- 
ental supervision." Themother of every fifth delinquent girlwasasex delinquent 
herself. Forty per cent of the fathers of the psychopathic delinquent chil- 
dren were alcoholic. The father of every fourth psychopathic child was 
guilty of non-support or family desertion. 

Only 13 per cent of the girls at the Girls' Opportunity Farm were diag- 
nosed "normal;" 40 per cent were cases of psychopathic personality; 21 per 
cent were cases of borderline mental defect or feeblemindedness. 

Of the 68 boys examined at the Boys' Opportunity Farm, only 11 were 
diagnosed as "normal;" 30 boys were either cases of borderline mental defect 
or were feebleminded; 15 boys were diagnosed as psychopathic personality. 

Out of 100 cases, being the "run-of-the-mine," at the Ohio Humane So- 
ciety, 06 per cent were found to be suffering from some nervous or mental 
abnormality. Twenty-six per cent were feebleminded and 8 per cent suffer- 
ing from mental disease. 

Of 200 individuals studied at the Hamilton County Jail, 74.5 per cent were 
classified as either cases of mental disease, mental defect, psychopathic per- 
sonality, epilepsy, psychoneurosis, or subnormal intelligence. 

Of a group of unmarried mothers (70 individuals), only 20 were classed 



as "normal;" there were 28 cases of borderline mental defect or feebleminded- 
ness, 10 subnormal individuals, 7 cases of psychopathic personality, 3 of 
psychoneurosis, and 2 of epilepsy. 



Dependency 



Of 359 children studied in connection with the Children's Home, the 
General Protestant Orphanage, the Bureau of Catholic Charities, and the 
boarding homes, 68.9 per cent were classified as "normal." This is quite in 
contrast to our group of delinquent children, of whom approximately two- 
thirds were found to be suffering from some gross nervous or mental abnor- 
mality. 

Of 61 adult individuals studied in connection with the Bureau of Catholic 
Charities, four out of every five were found to be handicapped by some ab- 
normal mental condition. 

Two hundred and twelve individuals were studied in connection with 
the United Jewish Social Agencies, as part of a survey of 50 dependent Jewish' 
families. It was found that 50 per cent of these individuals were suffering 
either from endocrine disorders, mental disease, feeblemindedness, epilepsy, 
or psychopathic personality. 

Of 122 persons studied as relief cases, in connection with the Associated 
Charities, being the "run-of-the-mine," approximately 72 per cent were classi- 
fied in terms of deviation from average normal mental health. 

Of a group of unemployment cases studied in connection with the Asso- 
ciated Charities, 71 per cent were found to be suffering from either endocrine 
disorders, epilepsy, mental deficiency, mental disease, or psychopathic per- 
sonality, or were distinctly subnormal in intelligence. 

Of 394 persons studied at the City Infirmary, only 20.3 per cent of the 
whites could be classed as "normal." All of the rest were either mentally sick 
or mentally crippled persons; among the 39 negroes at this institution, only 
three were diagnosed as "normal." 

Of 162 cases studied at the Hamilton County Home, it was found that 
only 4.5 per cent of the white persons could be classed as "normal" men- 
tally. All of the rest were either mentally diseased or mentally defective. All 
of the negroes were either feebleminded or insane. 

Public School Children 

In order to find out what proportion of the public school children are 
mentally handicapped, mentally maladjusted, and hence likely to furnish 
us with the grist for our future juvenile and adult courts, jails, delinquent in- 
stitutions, dependent institutions, unimprovable cases of dependency, unem- 
ployment, illegitimacy, and the like — a study was made of over 4,000 public 
school children, the idea being to get a fair picture of the average school 
child. Two per cent of the public school children were classified as feeble- 
minded, 2 per cent were cases of borderline mental defect, 3.5 per cent were 
diagnosed as nervous and psychopathic children, 4.8 per cent as subnormal, 
0.1 per cent were suffering from epilepsy and 0.7 per cent from endocrine 
disorders. 

It was also found that approximately 6 per cent of the public school 
children showed conduct disorders. 

It is, we believe, largely from these children in the public schools that 
our social problems of the future are to be drawn. Whatever we spend today 
in adequately studying, treating, and training these children will be returned 
one hundredfold tomorrow in the prevention of crime, insanity and depen- 
dency. 



MENTAL HYGIENE SURVEY 
AND RECOMMENDATIONS 



INTRODUCTION 

For several years Cincinnati has been a leader in many movements for 
social betterment and human welfare. In the field of mental hygiene, this 
city had already accomplished notable results in two definite directions — the 
field of juvenile delinquency and that of vocational guidance of public school 
children. The splendid work done by Mrs. Helen Woolley and Judge Charles 
Hoffman had served to attract considerable attention throughout this country. 
The work of these two pioneers in applying to the problems of the public 
schools and the juvenile court the scientific methods of psychiatry and psy- 
chology had already developed in the city of Cincinnati a widespread under- 
standing and appreciation of the mental hygiene movement. 

It was but natural that this should result in the development of a group of 
persons interested in mental hygiene, and thus the Mental Hygiene Council of 
the Public Health Federation had its origin. This group, in seeking to formu- 
late a program, decided to undertake a complete study of the mental hygiene 
situation in Cincinnati. 

An invitation from the Mental Hygiene Council of the Public Health Fed- 
eration was extended to The National Committee for Mental Hygiene to conduct 
this survey and, funds being available through appropriations made by the 
Rockefeller Foundation for this purpose, the invitation was accepted and the 
survey was initiated March, 1921. 

This survey, which has now been under way for approximately twelve 
months, has been completed and the present report is a presentation of the 
essential data gathered during the investigation. 

Scope of Survey 

The survey staff set itself to determine what sort of problems feebleminded- 
ness and insanity were to Cincinnati and Hamilton County; what part these 
and other mental conditions had to play in various social problems, par- 
ticularly chronic dependency, unemployment, outdoor relief, illegitimacy, 
family desertions, vagrancy, adult crime, and juvenile delinquency; and finally 
to determine the frequency of these abnormal mental conditions among public 
school children. 

The survey included, aside from the study of facilities of certain agencies 
and institutions, a careful examination of the "run-of-the-mine" of the cases 
coming in contact with the Ohio Humane Society, the Associated Charities, 
the Bureau of Catholic Charities, 50 dependent families in connection with 
United Jewish Social Agencies, the "run-of-the-mine" of the Juvenile Court, 
the Opportunity Farms for Boys and Girls, Hamilton County Jail, city and 
county infirmaries, the Home for the Friendless, the Catherine Booth Home, 
the Children's Home, the General Protestant Orphanage, the boarding homes 
children, and, finally, over 4,000 public school children. 

Methods Employed 

It was our object to secure in the case of each individual a careful and 
thoroughgoing physical, mental and social diagnosis. 

The mental examination included both psychiatric and psychological 
methods, the object being in each case, first, to rule out the presence of mental 



10 MENTAL HYGIENE SURVEY OF CINCINNATI 

disease; second, to evaluate the intelligence; third, to study the character 
and personality make-up of each individual. 

In the public school survey, group tests were used to rate intelligence. 
All children showing intellectual retardation were given individual psychologi- 
cal examinations. Likewise, each child received a careful physical examina- 
tion, a medical history, an educational rating, and a personality study. All 
children, then, who appeared to be retarded or showed conduct disorders or 
who gave a history of personality difficulties or in any way seemed to deviate 
from the average were given a prolonged, intensive examination. In addition 
to this a social investigation — a study of home conditions — was made in the 
case of those children who' were diagnosed as feebleminded, psychopathic, or 
epileptic. 

At the Juvenile Court our effort was to secure a picture of the routine 
problems presented, and a study of the "run-of-the-mine" was made. Each 
child was given a routine physical, psychiatric, and psychological, as well as 
a social, investigation. 

Individuals studied in institutions and in contact with various social 
agencies were given complete physical and mental examinations, but in general 
did not receive any special social investigation from our survey staff, and the 
valuable material gathered by these organizations was generously made avail- 
able and freely used. 

It might be worth while to mention here that in making comparative esti- 
mates of colored and white children in the public schools, and of colored and 
white individuals in the juvenile court, institutions, and social organizations, 
we did not apply the same standards for a diagnosis of feeblemindedness. In 
all instances we were more generous in our ratings of negroes, requiring a 
greater degree of mental retardation before making this diagnosis. 

It will be seen later on in the report that we refer frequently to personality 
difficulties and make some effort at rating individuals according to the out- 
standing picture that his personality make-up gives us: whether he is 
emotional — impulsive, restless, sensitive, nervous, excitable, easily discouraged, 
hot-tempered, "goes to pieces" under difficulties, cannot face situations frankly, 
«tc; or is egocentric — selfish, inconsiderate, calculating, without feeling and 
affection, individualistic, etc.; or is inadequate — weak-willed, suggestible, easily 
led, indolent, unambitious, apathetic, lacking in physical energy, etc. ; or is para- 
noid — suspicious, "persecutory," "has never had a chance or square deal in 
life;" or is a combination of these various types, or shows no very marked per- 
sonality difficulties. We appreciate fully how artificial any such classifications 
must ultimately be and how, from a clinical point of view, we will not be 
presenting all the facts in the case or always the most important facts simply 
through a mental diagnosis and a rating of a personality make-up. We fully 
appreciate, that any serious efforts at treating and adjusting human individuals 
must be based upon a more intimate and far-reaching knowledge of human 
forces within the individual himself than are outlined in a simple classification 
or terminology. However, the object of this survey was not to treat human 
individuals, but to point out the frequency and importance of certain outstand- 
ing factors that must be regarded in any comprehensive program for dealing 
with such phases of human conduct as would come within the scope of this 
report. 



DELINQUENCY 



This problem was approached through a study of the adult delinquents in 
the Hamilton County Jail, through cases coming in contact with the Ohio 
Humane Society, and through problems of illegitimacy handled by various 
agencies and institutions. We had hoped to study the "run-of-the-mine" of 
the municipal court, but owing to certain difficulties in organizing the machin- 



MENTAL HYGIENE SURVEY OF CINCINNATI 11 

ery of the court in order to make possible such a survey, we found the time 
involved prohibitive, this to the disappointment of some of the judges, who 
were anxious for the survey. Here is one of the largest and most serious 
problems facing Cincinnati. There pass through the municipal court of Cin- 
cinnati during one year approximately 14,000 cases — human derelicts, criminals, 
"ne'er-do-wells," wife beaters, prostitutes, thieves, and the most varied assort- 
ment of human failures to be found in contact with any other agency or insti- 
tution in the city. The amount of money spent in organizing machinery to deal 
with these individuals cannot be adequately estimated. Suffice it that it 
is a vast sum. The pity of it all is that we are failing to accomplish that which 
we set out to accomplish in dealing with these particular individuals. Almost 
half of them have been in court before, many of them a great number of 
times — ten, twenty, thirty, and fifty times. All studies of municipal court 
problems have shown the great frequency of serious mental and physical 
conditions amongst these offenders. This particular court has no machinery 
whatever for recognizing the insane, the feebleminded, and the physically 
diseased who are a menace to the general public, and because of this lack of 
proper facilities, is unable to extend to the general public that degree of protec- 
tion which it has a right to demand. 

The juvenile delinquent was studied in the Juvenile Court and at the 
Opportunity Farm for Boys and the Opportunity Farm for Girls. At the Juve- 
nile Court we studied 157 delinquent children, constituting the "run-of-the- 
mine" of this court for the period of our survey. At the Opportunity Farms 
we studied all of the boys and girls under commitment at the time of our 
investigation. 

JUVENILE DELINQUENCY 

THE JUVENILE COURT 

The Court of Domestic Relations of Cincinnati is divided into the Juvenile 
Division and the Divorce Division. The Divorce Divison includes the Mothers' 
Pension and Dependency Department. In the Juvenile Division are the Boys' 
Delinquent Department and the Girls' Delinquent Department. 

STAFF 

The staff of the court consists of the judge, one chief probation officer, two 
assistant chief probation officers, sixteen probation officers, two physicians, 
one of whom is a psychiatrist, two psychologists, clerks and stenographers. 

JURISDICTION 

The court is unusual in that it deals with the family as a unit and endeav- 
ors to touch all phases of the problems presented. The court has exclusive 
jurisdiction "in all children's cases under the Juvenile Court Act, all cases 
contributing to the dependency and delinquency of children, all cases of 
divorce and alimony, and in addition thereto concurrent jurisdiction with the 
Police and Criminal court in cases of failure to provide — sometimes desig- 
nated as desertion cases." (Annual report of Court for the year ending 
September 31, 1919.) 

The court attempts to adjust as many cases as possible without official 
action. The unofficial cases are increasing in number year by year. The 
hearings in these cases are privately conducted by the assistant or chief proba- 
tion officers. The more serious cases are heard by the judge and given 
his official sanction, while in the less serious cases the judge hears a synopsis 
of the case and legalizes the action. These cases are placed on official and 
unofficial probation. Official probation includes regular visits on the part of 
the probation officer, while in the unofficial cases the probation officer 
makes less frequent visits and extends only general supervision to the indi- 
vidual. 



52 



MENTAL HYGIENE SURVEY OF CINCINNATI 



QUALIFICATIONS OF PROBATION OFFICERS 

While there are no professional qualifications for appointment of proba- 
tion officer, the appointments are made through the State Civil Service Com- 
mission. 

CLINICAL FACILITIES OF THE COURT 

The clinical staff at the court consists of two physicians, one of whom is 
a psychiatrist, and two psychologists. They examine only those cases referred 
as presenting special problems or because of suspected mental abnormality. 
The psychiatrist is paid by the court on a part-time basis and acts in the 
capacity of a consultant. The psychologists are under the supervision of the 
Vocation Bureau of the Cincinnati Public Schools, and give full time to their 
court work. Of the 432 cases sent to the psychologists for psychological exam- 
inations last year, only 39, or 9 per cent, were referred to the psychiatrist for 
study. This is unfortunate, as every serious problem behavior case is funda- 
mentally a psychiatric problem. This the court fully appreciates and depre- 
cates the lack of funds for more adequate facilities. The psychiatrist or a 
psychologist, or both, attend the court hearings. > 

Except in the case of girls, no routine physical and serological examina- 
tions are made. Through the contact made with the Neurological Department 
of the Cincinnati General Hospital, special cases may be placed in the Neuro- 
logical Ward for observation pending diagnosis. 

ANALYSIS OF MATERIAL GATHERED 

Our problem was to study the human material that formed the grist of 
the Court's mill. To this end careful physical, psychiatric and psychological 
examinations were made, and medical and behavior histories were taken, of 
a group of unselected cases. In addition to this, social investigations were 
conducted in the case of each child; home conditions and other environmental 
influences were studied. 

Of the 201 cases examined at the Juvenile Court, 44 were mothers' pension 
'and dependency cases, and 157 were classed as delinquency cases. Of the 157 
delinquents examined, 69.4 per cent were males and 30.6 per cent were females. 

The race of these individuals was as follows: 70 per cent were native-born 
white persons of native-born parents; 16.6 per cent were native born white of 
foreign born parents; while 13.4 per cent were negroes. 

These percentages show that the larger portion of the cases were native- 
born whites of native-born parentage. The only other significant percentage 
is furnished by the negro group. The actual ages of these children varied 
from 6 to 17 years. The median chronological age was 15 years. 

Approximately 36 per cent of these children were repeated offenders — had 
been in court before, some of them a great many times. 

Table number 1 gives some idea of the school retardation of these children: 



TABLE I. 
CHRONOLOGICAL AGES OF CHILDREN UPON LEAVING SCHOOL- 
CLASSIFIED ACCORDING TO GRADE ATTAINED 



Chronological 

Age Total 

7 years 1 

9 years 1 

10 years 4 

11 years 8 

12 years 10 

13 years 28 

14 years 31 

15 years 37 

16 years 32 

17 years 5 



Second 
Grade 



Third 
Grade 



Fourth 
Grade 



Fifth 
Grade 



Sixth 
Grade 



Seventh 
Grade 



3 

7 
6 

16 
7 
1 



Eigth High 
Grade School 



8 

8 

10 

10 



TOTAL 157 



24 



26 



40 



36 



16 



MENTAL HYGIENE SURVEY OF CINCINNATI 



13 



It is interesting that 16 children were in high school, and that 102 children 
were in the sixth, seventh, and eighth grades. The amount of retardation 
is more clearly expressed in table number 2: 

TABLE 2— SCHOOL RETARDATION 





MALES 


FEMALES 


TOTAL 


RETARDATION 


Number 


% 


Number 


% 


Number 


% 


None 


33 


30.3 


9 


18.7 


42 


26.8 


Retarded 1 year 


30 


27.5 


5 


10.4 


35 


22.3 


Retarded 2 years 


27 


24.8 


18 


37.5 


45 


28.7 


Retarded 3 years 


11 


10.1 


8 


16.7 


19 


12.1 


Retarded 4 years 


7 


6.4 


4 


8.3 


11 


7.0 


Retarded 5 years 


1 


.9 


3 


6.2 


4 


2.5 


Retarded 6 years 














Retarded 7 years 






1 


2.1 


1 


0.6 


TOTAL 


109 


100.0 


48 


100.0 


157 


100.0 



It is interesting that 73.2 per cent of the children were retarded one year 
or more. It is also evident that a greater number of girls were retarded than 
of boys. A careful study of the past careers of these children was made, and 
certain important facts were brought out. Table Number 3 shows the fre- 
quency of past behavior difficulties in this particular group of Juvenile Court 
cases: 

TABLE 3— BEHAVIOR HISTORY 



Number outstanding 
Behavior 


BOTH 


MALES 


FEMALES 


Number 


% 


Number 


% 


Number 


% 


behavior difficulties. 

Stealing 

Pugnacity 


29 
44 
15 
25 

5 
7 
7 
2 
18 
5 


18.5 

28.1 
9.5 

15.9 
3.2 
4.4 
4.4 
1.3 

11.5 
3.2 


24 
42 
12 

5 
4 
2 
2 
14 
4 


22.1 

38.5 
11.0 

4.6 
3.7 
1.8 
1.8 
12.8 
3.7 


5 

2 

3 

25 

3 
5 

4 
1 


10.4 
4.2 
6.2 


Sex delinquency 

Sex perversion 

Lying 


52.1 
6.2 


Incorrigible 

Gambling 

Truancy 

Vagrancy 


10.4 

8.3 
2.1 


TOTAL 


157 


100.0 


109 


100.0 


48 


100.0 



Eighty-one and five tenths per cent of these cases showed in their careers 
previous evidence of socially unacceptable conduct. It is clear that stealing 
and sex delinquency constitute the two outstanding behavior difficulties. It is 
interesting to note that 18.5 per cent gave no history of past conduct disorders. 
This group almost altogether constituted those cases that were dismissed from 
court or that were guilty of minor first offences with no previous career of 
misbehavior. It is also significant that 22.1 per cent of the boys gave no 
history of past behavior difficulties, while only 10.4 per cent of the girls gave a 
history of no past behavior difficulties. More than half of the girls were guilty 
of sex offences. 

INTELLIGENCE RATING 

By means of the Stanford revision of the Binet-Simon tests, the mental 
age of the individual was determined in each instance as distinct from the 
individual's chronological age. The relation of the mental age and the chronc- 
logical age is expressed by the so-called "intelligence quotient," which is the 



14 



MENTAL HYGIENE SURVEY OF CINCINNATI 



result obtained by dividing the mental age in months by the chronological 
age in months. In the intelligence quotient, or "I. Q." we have a numerical 
expression of the intellectual status of the individual. Experience has given 
certain rough values to the various intelligence quotients. Thus individuals 
making an intelligence quotient of between 90 and 100 are called "normal" 
in so far as their intelligence is concerned. Those making an intelligence quo- 
tient of below 60 are usually mentally defective. These classifications are not 
hard and fast, but are of great aid in arriving at a final mental diagnosis. 
(We did not limit our diagnosis of mental defect to include purely an intelli- 
gence estimate.) The distribution of these intelligence quotients is shown 
in Table 4: 

TABLE 4— INTELLIGENCE QUOTIENTS 



Intelligence Quotient 



Number 



Per Cent 



40-49 


4 


50-59 


1 


60-69 


17 


70-79 


29 


80-89 


43 


90-99 


30 


100-109 


17 


110-119 


8 


120-130 


1 


Unascertained 


7 



2.5 

0.6 

10.8 

18.6 

27.4 

19.1 

10.8 

5.1 

0.6 

4.5 



TOTAL 



157 



100.0 



Only 3.1 per cent had so low an intelligence quotient as 60 or under; while 
13.9 per cent had an intelligence quotient of 70 or under. It will be observed 
that marked inferiority of intelligence is not an outstanding and important 
causative factor to be considered in these cases. Sixty-three per cent or 
approximately 2 out of every 3 persons, had an intelligence quotient over 80. 
The problems presented by these cases are primarily behavior conditions, 
conduct disorders, mental maladjustments, in which intelligence testing is of 
relatively secondary importance, but in which careful career studies from a 
medical and psychiatric point of view are fundamental. Judge Hoffmann's 
strong appeal for proper equipment along these lines should receive wide- 
spread approval. Table 5 shows the relation of mental age to chronological 
age: 



TABLE 5— MENTAL AGES OF CHILDREN CLASSIFIED ACCORDING TO 

CHRONOLOGICAL AGE 



Chronological 
Age 



Total VI VII VIII 



7 years 1 

9 years 1 

10 years 4 

11 years 8 

12 years 10 

13 years 25 

14 years 25 

15 years 27 



lb years 25 

17 years 21 

18 years 7 

20 years 1 

Unascert'n'd. 2 



1 



IX 



XI 



Unascer- 
XII XIII XIV XV XVIt'n'd. 



TOTAL ..157 



15 24 21 24 22 16 13 9 2 



MENTAL HYGIENE SURVEY OF CINCINNATI 15 

MENTAL DIAGNOSIS 

A fuller understanding of the behavior of these individuals and of their 
failure to profit by ordinary methods in the school, at home, and out in society, 
may be had from table 6: 

TABLE 6— MENTAL DIAGNOSIS 

Diagnosis Number Per Cent 

Normal 25 15.9 

Dull normal 30 19.1 

Subnormal 16 10.2 

Mental defect 13 8.3 

Borderline mental defect 19 12.1 

Psychopathic personality.... 49 31.2 

Endocrine disorder 4 2.5 

Epilepsy .1 0.6 

TOTAL 157 100.0 

Inspection of this table shows that approximately 65 per cent of the cases 
presented a problem of some type of mental ill health or mental and nervous 
abnormality. Since only 8.3 per cent of the cases were classed as feeble- 
mindedness, it is evident that the chief problem of the court, so far as mental 
diagnosis is concerned, is not to be found in this group. 

The psychopathic group, however, represented by nearly one-third (31.2 
per cent) of the cases, is more important to consider. Among the character- 
istics of the psychopath are emotional instability or inadequacy, defective 
judgment, and other personality difficulties and character defects that are par- 
ticularly conducive to delinquent conduct. The conservatism c s the diagnoses 
is shown by the comparatively large percentages of "normal" and "dull 
normal" (35 per cent.) (By this we do not mean that these so-called "normal" 
delinquents were all well adjusted, mentally healthy persons with no char- 
acter defects. They were all problems justifying thoughtful consideration.) 

RACE AND MENTAL DIAGNOSIS 
Twenty-one, or 13.4 per cent, of the cases were negroes. This negro 
group was compared with the native-born white group so far as diagnosis is 
concerned. The native-born white group were of parents who were also 
American born. We have here a comparison of pure native-born stock with the 
negro group, and while our total number of cases is too small to serve as a 
basis for conclusions, it is interesting to note that of the negroes over one- 
third were mental defectives, while of the native-born whites of native paren- 
tage, only a sixth were so grouped. On the other hand, over one-third of the 
native whites were psychopathic, while only slightly over one-fourth of 
the negroes were so designated. 

SEX AND DIAGNOSIS 
The percentage distribution of the various diagnostic groups by sex is 
shown in table 7: 

TABLE 7— MENTAL DIAGNOSIS BY SEXES 

MALES FEMALES 

Diagnosis Number Per Cent Number Per Cent 

Normal 1 44 40.4 11 22.9 

Subnormal 12 11.0 4 8.3 

Mental defect 2 21 19.2 11 22.9 

Psychopath 28 25.8 " 21 43.7 

Other diagnoses 4 3.6 1 2.1 

TOTAL 109 100.0 48 100.0 

1 Includes dull normal 2 Includes borderline mental defect 



16 MENTAL HYGIENE SURVEY OF CINCINNATI 

It becomes evident that the delinquent girl presents a very different 
problem from the boy. Of all the boys examined in court, 40.4 per cent were 
classified as normal, while only 22.9 per cent of the girls were placed in this 
group. It may be remarked that nearly half of the girls were diagnosed as 
psychopathic, while only one-fourth of the boys were so designated. 

MENTAL DIAGNOSIS AND FREQUENCY OF OFFENSE 

Exactly 100 cases or 63.7 per cent of the total number, were making their 
first appearance in court. 

Fifty-eight per cent of those appearing in court only once were handi- 
capped by some nervous or mental abnormality, while 91 per cent of the 
repeated offenders were mentally handicapped. Of those appearing in court 
once, 21 per cent were psychopathic, while 49.2 per cent of the recidivists were 
psychopathic. Feeblemindedness is not as important a problem amongst the 
recidivist group as psychopathic conditions, for approximately half of all those 
children who appeared in court more than once were diagnosed as psycho- 
pathic. 

PERSONALITY MAKE-UP 

The following table shows the frequency of personality handicaps amongst 
these delinquent individuals. 

TABLE 8— PERSONALITY MAKE-UP 

Personality Number 

No outstanding personality difficulties 25 

Emotional 45 

Egocentric 16 

Inadequate 54 

Mixed 17 

Total 157 

One hundred and thirty-two individuals, or approximately 84 per cent 
of the total number showed some form of character defect or personality dif- 
ficulty. Seventy-eight per cent of first offenders showed marked personality 
difficulties, while 93 per cent of the repeaters showed personality difficulties. 

Of the 17 cases who were classified as normal and with no outstanding 
personality difficulties, 16 were brought into court for the first time. In other 
words, practically all of these 17 cases represented a really normal group and 
presented no very difficult problems to the court, certainly in so far as re- 
cidivism is concerned. 

One out of every three delinquent children appearing before the court 
was a repeated offender, and approximately all of these repeated offenders 
showed marked character defects and personality handicaps. These we believe 
to be matters of great importance in understanding the make-up of the re- 
peated offender. 

PHYSICAL CONDITION 

Very careful physical examinations were given to every child. Table 9 
shows the frequency of certain outstanding conditions. 



MENTAL HYGIENE SURVEY OF CINCINNATI 



17 



TABLE 9— PRINCIPAL SOMATIC DISEASES AND DEFECTS 



Enlarged Thyroid 

Heart conditions 

Enlarged and diseased tonsils 

Adenoids 

Malnutrition 

Enuresis 

Clinical symptoms of 

tuberculosis 

Defective teeth 

Enlarged cervical glands... 

Anemia 

Defective speech 

Clinical symptoms of 

syphilis 

Defective vision 



Number 



Per cent 



60 


38.2 


22 


14.0 


32 


20.4 


5 


3.2 


28 


17.8 


7 


4.5 


8 


5.1 


8 


5.1 


12 


7.6 


13 


8.3 


12 


7.6 


10 


6.4 


15 


9.6 



Approximately 80 per cent of these children showed some physical defect 
or disease or evidence of physical ill health. The importance of these con- 
ditions in considering the child's future health and general welfare should 
hardly require special emphasis here. Yet the subject in its broad sense has 
received too little attention particularly in its relation to the child's mental 
condition and conduct. 

We have pointed out that intelligence as determined by psychological 
tests is not the fundamental factor involved in delinquent conduct. We have 
called attention to the fact that two-thirds of the problem cases amongst ju- 
venile delinquents have I. Q.'s over 80. We have shown that their difficulty 
lies mainly in the field of character and personality make-up, that mental 
conflicts and mental maladjustments are common. 

These are psychiatric questions and should be approached from the medi- 
cal point of view. The physical make-up of the individual is the foundation 
of his personality. The integrity of the various internal organs has much to 
do with mental health. Their balanced functioning is essential not only to the 
physical health of the child, but to the maintenance of normal mental health 
as well. 

The importance of physical factors was brought out in a study made 
by the writer in the Municipal Court of Boston. "One thousand adult delin- 
quents were studied with the purpose in view of determining what part, if 
any, routine physical examinations might play in the disposition of a delin- 
quency case in court, and later in the institution of reconstructive measures 
while on probation. It was found that 85 per cent of those in good or fair 
physical condition had been and were still self-supporting, while 18 per cent 
of those found to be in poor or bad physical condition had been and were 
still self-supporting; that 96 per cent of those regularly employed were found 
in good or fair physical condition, while only 4 per cent were found to be 
in poor or bad physical condition; that 86.3 per cent of those who were rated 
as "never worked" were found to be in poor or bad physical condition. The 
chances of being self-supporting were more than 4 to 1 in favor of the in- 
dividual in good physical condition. 

"Further, 47 per cent of these individuals, practically every other person, 
was suffering from syphilis or gonorrhea. Only positive laboratory findings 
were included. 

"Certainly, something more than intelligent advice, short terms of con- 
finement in prison, general supervision in the community and securing em- 
ployment is needed to solve the problem presented by the delinquent whose 
physical endurance is rapidly diminishing under a progressive Bright's disease, 
or the delinquent who is scattering venereal disease into the community. These 



18 MENTAL HYGIENE SURVEY OF CINCINNATI 

may be conditions of more vital importance to his future welfare and to that 
of the community in which he lives than any other consideration." 

The great importance of a searching physical investigation is now made 
evident from the frequency with which disorders of the ductless glands are 
encountered. The relationship of endocrine conditions, prolonged ill health, 
physical disease, malnutrition, etc., to behavior need not further be elaborated 
here. 

THE SOCIAL ENVIRONMENT OF THE JUVENILE 

A picture of the environment of 157 children in the Juvenile Court was 
the aim of the psychiatric social investigation. 

SOURCE AND TYPE OF INFORMATION 

A home visit and an interview with the mother and father, information 
secured from neighbors and relatives, careful reading of court and social- 
agency records, were the sources of information used. A family history, with 
particular reference to physical and mental defect and social maladjustments, 
was secured. A personal history, including prenatal and developmental con- 
ditions, as well as the story of later school work and behavior difficulties, 
was sought. 

In order to evaluate statistically the complex factors in the homes and 
neighborhoods, a numerical value or index was given to each home and each 
neighborhood from which the delinquent came. Detailed descriptions of the 
method of scoring these homes and neighborhoods will be given in the dis- 
cussion of such data for the problem school children, and will be briefly 
mentioned before the record of the statistical findings in this phase of the 
report. 

GUARDIANSHIP OF THE CHILD 

The child who has been brought up by one parent alone, or who has 
had foster parents, or who has been placed in an institution, has frequently 
lost what he can never regain — a normal family environment. The loss of 
one parent by death is undoubtedly a handicap. 

Fifty-two per cent of these children are not living in homes with both 
parents. A close connection between the delinquency of the child and failure 
in guardianship conditions is shown in the following illustrative cases: 

Edward was placed in a custodial institution for boys by the Juvenile Court a year before 
our examination because he had stolen a bicycle. He is now 16 years r>ld and had h Q en 
at the Special School for Mental Defectives for two years. At the time of our examination 
he was again in Juvenile Court because he had persistently run away from the institution 
in which he had been placed. 

Examination brought out that he was a fairly well developed boy suffering from thyroid 
disorder. Psychological tests revealed an intelligence level of nine years. Certain person- 
ality difficulties were present. Edward was bad tempered and frequently fights without 
much provocation. He prefers to stay by himself most of the time, however — just likes to 
"sit around." When asked as to why he ran away from the institution, Edward was able 
after considerable thought to state that he "just wanted to see some friends." He said he 
had not been unhappy but just got tired and walked off. 

A psychiatric social investigation was made in this case to determine what factors in 
the home or heredity might have contributed to the delinquency of the boy. Edward was 
found to be living in a home which ranked much below the average. The home score was 
ten. Experience has indicated that any score below 13 is markedly detrimental to the best 
interests of the child. In Edward's home there was no marked deficiency in such items as 
neatness and necessities. The family had enough to eat and wear. In size the situation in 
the home was not so favorable. The father and eight children were living in four rooms 
in a tenement. It is in the items of parental supervision and parental conditions that the 
:hief deficiencies are indicated; the home receiving the lowest possible scores on both items. 
Edward's mother died before Edward's first delinquency. Edward's father is illiterate and 
alcoholic. He had deserted the family on several occasions. Edward's family have been 
in contact with social agencies, according to the Confidential Exchange, since 1917. 

It was further found that Edward had a feebleminded and syphilitic brother. Another 
brother was illiterate and a sister was in a correctional institution for girls as a sex delinquent. 

We have in Edward's family a group of individuals who have already contributed de- 
linquents to the community. A background is furnished for this mentally defective boy 
which causes him to be not unaccustomed to delinquent behavior. 



MENTAL HYGIENE SURVEY OF CINCINNATI 19 

VAGRANCY 

Lester, white, age 16. Intelligence Quotient, 63. Diagnosis, feebleminded. Personality, 
inadequate. Offense, vagrancy. Home Index, 11. Neighborhood Index, 9. 

Personal History and Guardianship Conditions. Mother died ten years ago. Father im- 
mediately sent his four children to the court for placement. The three girls were placed 
in gcod foster homes where they are still doing well. Lester was placed in an orphanage. 
He ran away at every opportunity. He was sent to the Boys' Opportunity Farm. He again 
ran away. He was taken by an aunt who well intentioned, but ignorant, provided a home 
in no way attractive. He was unable to keep a job for more than a few weeks. At the 
time of the examination he was in poor physical condition. He had congenital cataract, 
defective speech, and there were clinical evidences of congenital lues. He was in court 
for again running away. 

Remarks. Three make-shift homes have failed. A boy with a defective heredity — 
an alcoholic father who deserted and mistreated his family, and a mother who died of tuber- 
culosis — has been placed in environments where he never obtained intelligent supervision. 
Feebleminded, but in no way vicious, he has nevertheless been a recurring problem to the 
court. 

TRUANCY 

Robert, white. Age 13. I. Q., 100. Diagnosis, Psychopath. Personality, Emotional. 
Offense, Truancy. Home Index, 9. Neighborhood Index, 15. 

Personal History and Guardianship Conditions. Father who was alcoholic deserted 
family when Robert was 9. Mother secured a divorce and married an Indian. This step- 
father is in no way unkind to the boy but Robert protests violently that his mother should 
never have married again and that if she was to do so she should have married " a white 
man." He insists that he hears voices calling him in his dreams to leave home. So far 
there has been no actual attempt to run away though there is rarely a day that he does 
not threaten to do so. But there is almost continued truancy from school. He is entirely 
uninterested in his older sister who has been a sex delinquent. His only concern is for his 
mother and this he usually manifests by extreme denunciation of her actions. 

Remarks. Both the mother and the step-father are entirely lacking in appreciation 
of the boys abnormal reaction to the home situation. 

Charles, white. Age 12. I. Q., 119. Diagnosis, Pre-psychopathic. Personality, Emotional. 
Offense, Stealing. Home Index, 19. Neighborhood Index, 25. 

Personal History and Guardianship Conditions. Father who was an artist died when 
the boy was ten. Mother placed two of the children in an orphanage but has kept Charles 
with her. Sh? runs a boarding house and has little time to supervise the activities of her 
son. Before the father's death temper tantrums were unusual and never resulted in any 
thing but punishment. New the mother, too busy to struggle with the boy, will first refuse 
him something and then will acquiesce when he becomes excited. He has now been in court 
twice for "taking things" he wanted but which had been denied him at home. 

Remarks. The supervision and discipline of this quick tempered and neurotic child 
has been entirely in the hands of an inadequate mother who recognizes his difficulties but 
is unable to cope with them. 

While it cannot be definitely stated that the cause of a child's delinquency 
lies solely in ruptured home conditions, it can be stated that these are im- 
portant factors to be considered. In the first case, the boy has since six years 
of age never been in a normal home. He was placed with an aunt who, unin- 
telligent and slovenly, provided a home in no way attractive and exercised 
a supervision that was sporadic and inadequate. In the second case, the boy 
protested against the remarriage of his mother and manifested the greatest 
repugnance to his Indian step-father. His persistent truancy may have repre- 
sented an attempt to escape from unfavorable home conditions. In the last 
case, the deficiency in guardianship results from the attempt of an inadequate 
mother, without the father's aid, to cope with an emotionally unstable child. 

This study shows that 58 per cent of the "normal" and dull normal 
children were living in their own homes with their own parents; while 
only one-third of the psychopathic children were living in their own homes 
with their own parents. Two-thirds of the psychopathic children were living 
under guardianship conditions that produced a great strain upon the child. 

Approximately three out of four of the children showing no marked 
personality handicaps w T ere living in homes where both parents were present; 
while only 43 per cent of the children with personality handicaps were living 
in such homes. 

THE ONLY CHILD 

Approximately one-third of the juvenile delinquents were either only 
children or had but one brother or sister. Nearly one-half of the psycho- 



20 MENTAL HYGIENE SURVEY OF CINCINNATI 

pathic children were either only children or had but one brother or sister. 
More than twice as many of the psychopathic delinquents as of the normal 
children came from small families. 

The relationship of the development of personality difficulties to size 
of families is interesting. This study shows that those children with marked 
egocentric make-up came from families where they were the only children. 

The following case is that of an only child: 

Thomas, white. Age, 15. Intelligence Quotient. 87. Diagnosis, Psychopathic personality, 
Personality make-up, Emotional, unstable, impulsive, violent tempered, sensitive, moody. 
Offense, perverted sex practices with smaller boys. Home Index, 10. Neighborhood Index, 16. 
Thomas is an only child; mother and father constantly quarrel; home life very unhappy. 
There has never been a divorce, but parents periodically separate and then return to each 
other. Mother is a sex delinquent, and father is an alcoholic. The paternal grandmother 
was insane, and an aunt and uncle are "queer." Thomas is in the seventh grade in school, 
having repeated the fifth and sixth grades. His general physical condition is good. There 
has been a past history of repeated stealing. He has been before the Juvenile Court several 
times before. On one occasion he was placed in an orphanage. There he indulged in perverted 
sex practices with small boys. 

This case is used simply to stress the influence of an indifferent father 
and mother, whose unhealthy adaptations to life are important causative fac- 
tors in the delinquency of their child. 

SOCIAL MALADJUSTMENTS IN THE FAMILY 

We have used the term "social maladjustment," to cover a wide variety 
of conditions found within the family of the child. We cannot say definitely 
to what extent these cause delinquent conduct. The material obtained was 
gathered through personal interviews, court, and social agency records. Evi- 
dence of mental defect, marked retardation in school, serious personality han- 
dicaps, cases of insanity, epilepsy, various physical diseases and disabilities, 
criminal and delinquent records, extreme cruelty in the home, alcoholism, 
illiteracy, etc., were recorded. 

In 89 per cent of the families, we found evidence of one or more of the 
above mentioned social maladjustments. 

The average number of maladjustments per family of the delinquent chil- 
dren diagnosed as normal or dull normal was 1.9 per cent; for the group 
diagnosed as psychopathic, 2.5 per cent; and for the mental defectives, 3.2 
per cent. 

Families of approximately all of the psychopathic children included in 
this group showed delinquent tendencies. A great variety of types of delin- 
quency were noted. For instance, 20 per cent of the mothers were sex delin- 
quents; 25 per cent of the fathers of the psychopathic children had been 
guilty of desertion and non-support; 40 per cent of the fathers of the psycho- 
pathic children were alcoholic. 

As illustrating the average case with several social maladjustments in the 
family, the following case may be used: 

Samuel, Jewish. Age 12. Intelligence Quotient, 79. Diagnosis, Borderline mental defect 
and psychopathic personality. Personality make-up, Emotional, unstable, impulsive, sensitive, 
hot-tempered, restless, etc. Offense, Stealing. 

Mother and father are illiterate. Father is alcoholic and has one jail record. Mother, an 
invalid, has "sick headaches" during which she is frequently in bed for days. One of 
Samuel's brothers is in the Special School for Defectives; another brother, who is 6 years 
old, is in the State Institution for Epileptics; a sister, 10 years old, is at home because she 
doesn't "learn right." Another sister is a cripple. 

Personal History. Prenatal, birth, and developmental history normal. Began school 
when 6 years of age and was immediately transferred to the Special School for Defectives. 
He has repeated each grade there. At present he is in poor physical condition, malnourished 
and with a nervous heart. Six months ago he began to steal. He says, "I can't help taking 
things. I take them whether I want them or not." In addition to being a high-grade mental 
defective, the boy in this case is faced by the problem of living in a family every one of 
whom is mentally or physically handicapped. He is handicapped by both his biological and 
his social heredity. 

We have found that the families of mental defectives furnish a greater 
number of individuals who have manifested social maladjustments than any 
other type in this study. 



MENTAL HYGIENE SURVEY OF CINCINNATI 21 

The delinquent boy or girl in the Juvenile Court presents a great variety 
of problems, one of the most important of which is the family stock and 
social environment from which they come. 

HOME INDEX 

In securing a home index, information was sought on each of the fol- 
lowing five points: 

1. Necessities: the status of the home with reference to the 
ordinary needs of life. 

2. Neatness: the condition of the home in regard to 
order, sanitation, and health. 

3. Size: relative size with reference to the number of per- 
sons living in the home. 

4. Parental condition: intelligence and degree of harmony 
obtaining in the home and moral training of the child, 
etc. 

5. Parental supervision: the amount and fairness of con- 
trol exercised for the welfare of the children. 

Each of the five items was graded on a scale of five points, one point 
representing decidedly unfavorable conditions, five points representing fav- 
orable conditions, and two, three and four representing conditions of varying 
favorability between the two extremes. In determining these values, constant 
reference was made to the standard scoring sheet published by the California 
Bureau of Juvenile Research. 

The scores given to each of the five items w T ere added to obtain the home 
index. Experience has attached certain meanings to these numerical values. 
Homes giving total scores of 12 or below offer in general unfavorable con- 
ditions for the children living in such homes. A score of less than 9 indicates 
a very low social level; 18 w r as found to be the most frequent score for 
typical "middle-class" homes. These scores do not, of course, give full expres- 
sion to the many complex factors in the home that play so large a part in the 
growth of personality and the development of delinquent conduct, but they 
are valuable in that they give some rating of the social environment. 

Fifty-one per cent of these children were in homes that received a score 
of 12 or under, while 23 per cent were in homes of the very lowest rating, 
receiving scores of 9 or under. 

Approximately 25 per cent of the delinquent children in this study came 
from homes in which the lowest rating (1) was given to the items, "Parental 
conditions" and "Parental supervision," while 69.5 per cent came from homes 
receiving either 1 or 2 on "Parental conditions" and "Parental supervision." 
Many of these children, already handicapped by mental and physical con- 
ditions, are in homes in which there is friction, lack of intelligent interest, 
and practically no parental control or supervision. 

Unattractive, congested homes also seem to be a factor in the develop- 
ment of juvenile delinquency. Over half of the children come from over- 
crowded homes where there is but a minimum of privacy, making it neces- 
sary for the child to seek recreation and interests outside the home. 

Twenty per cent of the mentally defective delinquents came from homes 
receiving the lowest total score on all items, while 10 per cent of the psycho- 
pathic children came from such homes. 

Ninety per cent of the feebleminded children came from homes receiv- 
ing a score of 1 or 2 on "Parental conditions" (general intelligence, social 
adaptability, degree of harmony, etc., found among the parents). 

In regard to the physical surroundings in the homes, the chief failure 
seems to lie in the crowded conditions. The following case came from such 
a home: 

James, white. Age 15. Mental Diagnosis, Borderline mental defect. Personality make-up, 
Emotional, neurotic, unstable, impulsive, etc. Offense, Gambling. Neighborhood Index, 15. 



22 MENTAL HYGIENE SURVEY OF CINCINNATI 

Home Index, 8, (necessities, 1; neatness, 1; size, 1; parental conditions, 2; parental super- 
vision, 3). 

The mother and father and nine children lived in four rooms on the third floor of a 
tenement. The mother is illiterate, "sickly," has given birth to nineteen children, and is 
unable to give any degree of home control over James. 

Approximately 48 per cent of the children in this study lived in homes 
in which the item of size received one of the two lowest scores — (1 or 2); 
that is, there was considerable overcrowding. This is particularly a serious 
matter in the life of girls, not only because of the lack of privacy in their 
daily life, but because the lack of any place in which to receive friends tends 
to throw them out on the streets. 

The chief failure in the homes of those children diagnosed as psycho- 
pathic was in "Parental conditions" and "Parental supervision." The following 
case illustrates well the influence of bad home conditions: 

Charles, white. Age 13. Intelligence Quotient, 126. Diagnosis, Psychopathic personality. 
Personality make-up, Egocentric and paranoid. Offense, Stealing and repeated running away 
from home. Home Score, 12, (necessities, 3; neatness, 4; size, 3; parental conditions, 1; 
parental supervision, 1). Neighborhood Score, 14. 

Mother obtained divorce from alcoholic and syphilitic father and remarried within a 
year. Both she and the stepfather are exceedingly neurotic, very irritable, and over severe. 
They seem to have little real interest in the boy, but make constant demands upon him 
for service. Money which he earns as a newsboy is taken from him. Frequently he has 
rebelled, but always is forced into submission by severe whippings. He has finally been 
removed from home by the court. In this case there is no lack in any element of the ordinary 
physical conditions of the home (food, neatness, size, etc.), but the failure lies in the relation- 
ship between the child and its parents. It will be noted that the boy is above average in 
intellectual ability. However, he has been transferred from school to school because of 
constant truancy. He was finally placed in the Boys' Special, which handles such problem 
cases. The combination of a child with superior intelligence and unsympathetic and harsh 
parents has apparently resulted in serious maladjustments. 

HOME CONDITIONS OF GIRL DELINQUENTS 

When the findings of the survey staff in regard to diagnosis, personality, 
and behavior difficulties, frequency of offense, etc., were analyzed, it was 
found that the 48 girls presented a series of much more serious problems than 
did the 109 boys. A special study was, therefore, undertaken to see if an 
examination of the social environment of these peculiarly difficult cases could 
offer suggestive explanations as to the causes of their more serious delin- 
quencies. 

When the scores given the homes of these girls are studied, it is found 
that they consistently come from more unfavorable conditions than do the 
boys. Less* than half of the boys come from homes scoring below 13, over 
two-thirds of the girls come from such homes. 

When the values placed upon the various items are analyzed, it is found 
that the chief failure in the homes of these delinquent girls is in the parental 
conditions and supervision. Lower scores were given these two items than 
for any group studied. Ninety per cent had the very lowest scores of one 
or two on these two items. 

When the 48 cases are studied one after another, a conviction that the 
social environment of these girls played a most important determining role 
in the development of their delinquency can scarcely be avoided. Two cases 
are presented not because they are striking or unusual, but because they are 
typical; they represent the usual run of the cases found among the girl 
delinquents. 

Edna, white. Age 14. Diagnosis, normal. Personality make-up, inadequate. Offense, 
sex delinquency. Neighborhood Index, 13. Home Index, 9, (necessities, 3; neatness, 1; size, 
2; parental conditions, 1; parental supervision, 1). 

Family History. Father, hard-working, unintelligent, and uninterested in children. 
Mother clearly abnormal mentally, has frequent "fainting spells," has delusions of persecu- 
tion, considers herself too urtwell to leave the house, has long periods of deep depression. 
One brother married when 17 and deserted his wife before birth of first child. Another brother, 
aged 12, is now in the third grade and has been diagnosed feebleminded. Two sisters give 
a history of marked retardation in school. Three children have died in infancy. A maternal 
uncle committed suicide. A maternal aunt, though now 50 years old, is reported as being 
"crazy on men." The home is overcrowded. 



MENTAL HYGIENE SURVEY OF CINCINNATI 23 

Personal History. Prenatal, birth, and developmental history normal. Began school 
when G. Is at present in eighth grade and has never repeated a grade. She was brought 
into court as "incorrigible" by an older sister. She denied having had sex relations of any 
kind, but the examining physician reports that intercourse has undoubtedly been frequent. 
She admitted lying and "running the streets" at night. She has been placed upon official 
probation. 

Edna has made normal progress in school. As is indicated by the values given the 
various items that go to make up the home index, the housing conditions in the home are 
far from satisfactory. The mother, father, and four children, all over 12 years of age, live 
in four rooms over a garage. The one toilet in the building is shared with three other 
families, and is usually in filthy condition. The rooms themselves are always dirty and dis- 
orderly, the beds unmade, and the dishes unwashed. The values given the two items in 
regard to parental conditions and supervision are the lowest possible. The mother is proba- 
bly psychotic ; the father is entirely indifferent. So far as could be learned there was no 
attempt at supervision or moral training. The father when questioned about his 14-year-old 
daughter, then in detention at the Juvenile Court, shrugged his shoulders and said: "She's 
a little roughneck — time she got married." 

Lucile, white. Age 17. Intelligence Quotient, 14. Diagnosis, Feebleminded. Personality 
make-up, Inadequate. Offense, In court because pregnant. Accuses man of rape. Neighbor- 
hood Index, 13. Home Index, 6, (necessities, neatness, parental conditions, parental super- 
vision all score 1. size scores, 2). 

Family History. Father unable to work because of tuberculosis. Mother is feeble- 
minded and very emotional. Two brothers are feebleminded; one is now in state reforma- 
tory for rape and theft. One sister is known to be a mental defective and spent 3 years 
at the State Institution for Feebleminded. Another sister is 12 years old and is in the fourth 
grade. The family has registrations from 5 social agencies dealing with problems of health, 
2 dealing with delinquency, and 6 dealing with dependency. 

Personal History. The mentally defective mother could give no information in regard 
to prenatal or birth history. An older sister stated Lucile did not walk or talk until 2 years 
old. She was in the Special School for Defectives until 12 years old. Sent to State Institution 
for Feebleminded where she remained 3 years. Returned to Special School for Defectives. 
When 16 she secured employment in a shirt factory where she earned $15.00 a week. She 
has now appeared in the Juvenile Court accusing a man of rape. 

The conditions in the home of this defective delinquent defy description. 
The family is in actual want most of the time; they rarely have enough to 
eat or to wear. The rooms are filthy and the sanitary arrangements entirely 
inadequate. The father who lias tuberculosis does the cooking for the family. 
The mother goes out and does scrubbing. Eight children as well as the mother 
and father live in five small rooms. Neither of the parents are capable of 
intelligent supervision of the children. 

There is constant quarreling. Discipline for the younger children fluctu- 
ates between extreme laxness and severity which borders on cruelty; as for 
Lucille "she's got a job" and no supervision is attempted. 

A feebleminded girl, once institutionalized, has returned to a home that 
offers no protection and an environment that is in every way a detriment, 
and at the age of 17 she is to become an unmarried mother. 

Only two out of the 48 defective delinquents studied had a social environ- 
ment that could be considered in any way favorable to the best interests of 
the child. 

NEIGHBORHOOD INDEX 

Neighborhood as well as home conditions are of special significance in 
the development of juvenile delinquency. These conditions for the purposes 
of this study were given a numerical value or index, in much the same way 
as the homes previously described. 

Each neighborhood was graded on the following five points: 

1. Neatness, sanitation and modern improvements. 

2. Recreational facilities in the homes and neighbor- 
hoods. 

3. Institutions and establishments, educational, in- 
dustrial and social, with reference to their proba- 
ble moral effect. 

4. Social status of residents. 

5. Average quality of homes. 

A score of 5 on any one item was given when highly favorable condi- 
tions were found, and a score of one when very unfavorable conditions were 
present. The scores given, the five points are added to secure the final 



24 MENTAL HYGIENE SURVEY OF CINCINNATI 

neighborhood index. An index of over 20 indicates in general very favorable 
conditions; an index below 13 indicates unfavorable conditions; while an 
index below 9 indicates the very worst of neighborhoods. 

For the entire group of juvenile delinquents studied, 8=5 per cent live in 
neighborhoods scoring over 20, while 26.5 per cent live in neighborhoods scor- 
ing less than 13. Nearly on.e-half come from neighborhoods whose indices 
lie between 17 and 12, indicating that only fair social conditions prevail. 

NEIGHBORHOOD INDEX AND DIAGNOSIS 

When the neighborhood indices for the three important diagnostic groups 
— the normals, the mental defectives, and the psychopathies — are compared, 
a striking difference is at once manifest. 

The mental defectives as a group corns from neighborhoods that score 
much lower than do the children in the other two groups. The median 
neighborhood score for the normals is 15.43; for the psychopaths, 15.32; 
for the feebleminded, 12.83. Ninety per cent of the latter live in neighbor- 
hoods that score less than 17, the minimum for moderately favorable con- 
ditions. 

ANALYSIS OF NEIGHBORHOOD INDEX 

As regards the general conditions of sanitation and modern improve- 
ments, the neighborhood from which these three groups come do not differ 
to any considerable degree. 

When the values placed upon the other four items are contrasted, a dif- 
ference is noted. The larger per cent of mental defectives live in neighborhoods 
receiving the lowest scores. The following is a description of one of the 
neighborhoods in which mental defectives live: "Little room for recreation 
in the homes because of overcrowded conditions. The few cheap commercial 
amusements in vicinity are of low order — penny arcades, cheap dance halls, 
pool parlors, etc. The children play in streets and alleys." 

Only one child not a mental defective was found living in a neighborhood 
with such conditions. 

On the item, "social status of the residents," which includes an estimate 
of educational and vocational attainments, general moral level, and general 
behavior, the divergence is very marked. About half of both the normal and 
psychopathic children come from neighborhoods that scored three on this 
item — that is, to give a typical example of such a neighborhood, most of 
the residents had had a grade-school education. The wage earners were 
tradesman, skilled and unskilled laborers. The moral tone of the district 
was good and the inhabitants, as a whole, were quiet and well-behaved. About 
10 per cent of the normal and psychopathic children came from neighbor- 
hoods that scored four or five and showed even better conditions than those 
just outlined; while 70 per cent of the feebleminded children came from 
neighborhoods scoring less than three on this item; 40 per cent came from 
neighborhoods scoring one. The defective delinquent frequently has defec- 
tive parents, a defective home, and a defective neighborhood. 

Twenty per cent of these children came from neighborhoods with in- 
sufficient or unsatisfactory recreational facilities; 33 per cent came from neigh- 
borhoods where the social institutions were either unfavorable in the in- 
fluence they exerted or where there was a dearth of educational, industrial, 
and the right sort of social institutions. Nearly every one of these children 
came from neighborhoods where the general social status of the residents was 
rated low. 

CONTACT WITH SOCIAL AGENCIES 

In our discussion in the section on social maladjustments, we pointed 
out that juvenile delinquency is scarcely ever an isolated phenomenon, un- 
related to any other social problem. This becomes still more evident when 
we study the frequency of contact with organized social agencies in Cin- 
cinnati of the families of which our juvenile delinquents are members. We 



MENTAL HYGIENE SURVEY OF CINCINNATI 25 

get some idea of the cost of these socially maladjusted families when we find 
that over 60 per cent of them have had contact with at least one or more 
social agency in this city besides the Juvenile Court. When the cases were 
cleared with the Confidential Exchange, it was found that over one-third of 
the families have had contact with three or more agencies. It is apparent 
that the appearance of these children in Court is by no means the only prob- 
lem that their families have presented to the organized social agencies of 
Cincinnati. 

Agencies dealing with dependency, delinquency or general health prob- 
lems have already handled most of these families. The following case is 
presented as an illustration of the multiplicity of these contacts with or- 
ganized social work in Cincinnati. 

Harry, white. Age 14. Intelligence Quotient, 88; Diagnosis, Psychopathic; Personality, 
Egocentric; Offense, Incorrigible; Neighborhood Index, 14; Home Index, 9. 

Clinical Findings and Personal History. Harry has been in court 
six times as follows: loitering, 2; fighting, 1; incorrigibility, 1; stealing, 1; 
sodomy, 1. Delinquency began with stealing candy in the ten-cent 
store. Later arrested for selling papers at night and fighting. Sent 
to Opportunity Farm — ran away three times. Finally brought into court 
for bad sex practices. Has run away from home on numerous occasions 
and has been a vagrant. At the time of the examination Harry was in the 
seventh grade in the Special School because of truancy. Birth, develop- 
mental history and physical condition negative. Boy was stubborn, self 
centered, gave evidence of no feeling of social responsibility. Lies because 
he says "Everybody does it to get out of difficulties." When things get 
difficult at home, he runs away and enjoys a vagrant's existence. Father 
alcoholic and deserted family. 

Agencies Registered: Thirteen, as follows: 4 agencies dealing with 
delinquency, 3* dealing with dependency, 6 dealing with health. Family 
has been a client of social agencies since 1914 (no central registratons are 
available in Cincinnati before that time). 

This family have cost the community a large sum in money spent 
through organized social agencies. Harry is one of the most serious type of 
delinquents. The ultimate causes of the boy's delinquency are probably only 
hinted at in our brief survey investigation. It is probable that Harry will 
cost the community still more, since there is little in the family situation or 
home environment that is likely to make him a socially competent member 
of society. The ramifications in all fields of social maladjustments presented 
by these families is nicely illustrated by the large number of contacts which 
Harry's family has had with organized social work. 

SUMMARY OF JUVENILE COURT FINDINGS 

One hundred and fifty-seven delinquents were studied in the Juvenile 
Court. Sixty-nine and four-tenths per cent were males, and 30.6 per cent 
were females. A large proportion of all the cases were native born. 

The ages varied from 6 to 17 years. The median chronological age was 
15 years. Approximately 36 per cent of the children were repeated offenders. 
Seventy-three and two-tenths per cent of the children were retarded one or 
more years in school. A greater number of girls were retarded than of boys. 

Eighty-one and five-tenths per cent of the cases gave a history of previous 
conduct disorders. In other words, we have here, in the Juvenile Court, chil- 
dren whose careers showed delinquent tendencies very early in childhood. 
This points towards the wisdom of equipping our public schools to deal ade- 
quately with those children who begin early to show behavior difficulties. 

Sixtv-seven and five-tenths per cent of these individuals, better than two 
out of three persons, had an Intelligence Quotient of over 80. Marked re- 
tardation in intelligence is not the chief outstanding factor in the delin- 
quency of these children. However, approximately two-thirds may be classi- 
fied from a psychiatric point of view as suffering from some form of mental 
abnormality, either subnormal intelligence, borderline mental defect, feeble- 
mindedness, epilepsy, psychopathic personality, or mental disease. 

Fifty-eight per cent of the first offenders were handicapped by some 
nervous or mental abnormality, while 91 per cent of the repeated offenders 



26 MENTAL HYGIENE SURVEY OF CINCINNATI „ 

were mentally handicapped. It is also interesting to note that 93 per cent 
of the repeated offenders showed marked personality difficulties and character 
defects. Approximately 80 per cent of these Juvenile Court cases suffered from 
some physical defect or disease or from physical ill health. 

The social investigations show 7 ed that 52 per cent of the children are 
not living at home with both father and mother. Fifty-eight per cent of the 
normal and dull-normal children are living in their own homes with their 
own parents; while only one-third of the psychopathic children are living 
in their own homes with their own parents. 

For the whole group of juvenile delinquents, approximately one-third 
are either only children or have but one brother or sister. 

In approximately 89 per cent of the families, it was found that other 
members of the family had shown evidence of one or more social maladjust- 
ments. Families of approximately all the psychopathic children showed evi- 
dence of delinquent tendencies. 

A numerical value was placed on the homes and neighborhoods, informa- 
tion being sought on five points: 

1. Necessities. ' 

2. Neatness, sanitation, etc. 

3. Size. 

4. Parental conditions. 

5. Parental supervision and control. 

Each of the five items was graded on a scale of five points, one point 
representing the very lowest and most unfavorable conditions, five points rep- 
resenting the very highest and most favorable conditions, three and four 
representing conditions of varying favorability between the two extremes. The 
scores given to each of the five items are added to obtain the home index. 
Total scores of 12 or below offered unfavorable conditions for the children; 
9 indicated a very low social level; 18 was found to be the most frequent 
score for typical middle-class homes. 

Fifty-one per cent of the children were in homes that received a score 
of 12 or under, while 23 per cent of the children were in homes that received 
the very possible lowest rating. 

On the two items, "Parental conditions" and "Parental supervision," 25 
per cent of the delinquent children came from homes in which the lowest 
rating (1) was given. 

Ninety per cent of the mentally defective delinquents were in homes 
that received a score of 1 or 2 on "Parental conditions." Approximately 70 
per cent of all the children studied were in homes that received a rating of 
1 or 2, on the items of "Parental control and supervision" and "Parental con- 
ditions." 

Approximately 48 per cent of the children lived in overcrowded condi- 
tions, in homes receiving the lowest scores — 1 and 2 — on "size." 

Less than half of the boys came from homes scoring below 13; over two- 
thirds of the girls came from such homes. 

What has stood out all through this study is that the most important 
situation as regards home conditions — that is, so far as delinquency is con- 
cerned — has nothing to do with "neatness," "cleanliness," "sanitation," "food," 
and ordinary home necessities, but rather with the attitude of the parents 
in their own relation to each other, in the control and supervision and moral 
training of the child. Ninety per cent of these delinquent girls came from 
homes that received the very lowest scores possible on the items of "Parental 
conditions" and "'Parental supervision." 

The same method of scoring neighborhoods was employed. Each neigh- 
borhood was graded on the following five points: 

1. Neatness, sanitation, and modern improvements. 

2. Recreational facilities in the home and neighborhood. 

3. Institutions and establishments (educational, industrial, and social) 
with reference to their probable moral effect. 



MENTAL HYGIENE SURVEY OF CINCINNATI 27 

4. Social status of residents. 

5. Average quality of homes. 

For the whole group of juvenile delinquents, 8.5 per cent live in neigh- 
borhoods scoring over 20, while 26.5 per cent (more than one out of every 
four), live in neighborhoods scoring less than 13. Approximately one-half 
came from neighborhoods w r hose indices lie between 12 and 17. 

If this study shows anything, it points definitely to the fact that outside 
of the child himself, the chief cause for juvenile delinquency is not to be 
found in the neighborhood or the physical condition of the home, not in 
the character of food and the income of parents, not in the neatness and 
sanitation, but in the parents themselves, in their attitude towards each other 
and towards the child in their own personal influence, in their degree of 
home control and supervision, and in their moral training of the child. 

GIRLS' OPPORTUNITY FARM 

The Girls' Opportunity Farm is situated at Wyoming, Ohio, on a tract 
of 90 acres of land, and has a capacity for about 70 girls. The institution is 
run on the cottage plan, and there are four large brick buildings of a very 
modern type which house the girls. The institution is under the jurisdiction 
of the Director of Public Safety of the City of Cincinnati. It receives girls 
between the ages of 10 and 18 years, committed by the Juvenile Court. Aca- 
demic training is provided for all of the girls, grades from the first to the 
eighth being taught. Some of the girls go to the neighboring village high 
school. There are two teachers employed by and under the direction of the 
Cincinnati Board of Education. The girls receive industrial and vocational 
training. They work on the farm and are taught sewing, short-hand, typing 
and general domestic service. After commitment they remain here until in the 
opinion of the superintendent they are fit to be returned to the community. 
The average length of time that they spend in the institution is about one year. 
At the age of 21 they are formally discharged by the superintendent. All 
of the girls receive a physical examination. The hospital facilities are fair, 
and there is an attending physician. There is one parole officer. 

ANALYSIS OF MATERIAL GATHERED 

At the time of our study, there were 60 girls at the farm, each of whom 
received a physical, mental, and social diagnosis. Forty-seven were born 
in this country and had parents who were born in this country. 

The median chronological age for the group was 16 years, or one year 
higher than that of the Juvenile Court cases studied. Forty-four of the group 
lay between the ages of 15 and 17 years. Twelve and four-tenths years was 
the median mental age, while 15 of the group had a mental age of 10 or 
under. Table 10 shows the relationship of chronological age to mental age. 

TABLE 10— MENTAL AGES OF GIRLS CLASSIFIED ACCORDING TO 
CHRONOLOGICAL AGE 

VII VIII IX X XI XII XIII XIV XVIII 



Chronological 




Age 


Total 


10 years 


1 


11 " 


1 


13 " 


6 


U " 


8 


15 " 


17 


16 " 


27 



Total 60 



1 

1 1 12.. 

1 2 12 2 

2 2 2 4 6 1 
2 15 9 4 3 

5 7 8 15 14 ~6 



28 MENTAL HYGIENE SURVEY OF CINCINNATI 

TABLE 11— AMOUNT OF SCHOOL RETARDATION 

Normal school progress 6 

Retarded 1 year 14 

2 years 16 

3 " 10 

4 " 8 

5 " 3 

6 " 3 

Total, 60 

Fifty-four of these girls were retarded one or more years in their school 
work, rating this on the basis of their chronological age and school attainment. 
Twenty had been arrested more than once, were repeated offenders. Of 
those appearing in court more than once, almost half (44 per cent) were 
psychopaths, while only 22 per cent were cases of feeblemindedness or bor- 
derline mental defect. 

Fifty-five of the girls gave a history of previous behavior difficulties prior 
to the offense for which they were committed to the institution. This refers 
to truancy in school, lying, stealing, fighting, bad sex practices, etc. 
TABLE 12— MENTAL DIAGNOSIS 
Diagnosis Number 

Normal 1 8 

Subnormal 11 

Mental defect 2 13 

Psychopathic personality 24 

Psychoneuroses 3 

Endocrine disorder 1 

Total, 60 

1 Includes dull normal. 

2 Includes borderline mental defect. 

It is evident from the above table that we are dealing with a highly selected 
group. These girls in many instances were committed to the Farm only after 
the Juvenile Court had exhausted all other means of dealing with the problem 
There were only 8 who were diagnosed as normal. The most outstanding 
feature is the very large frequency of psychopathic types — 24 out of 60. 
TABLE 13— PERSONALITY TYPES 

No outstanding personality difficulties 3 

Emotional 24 

Egocentric 8 

Inadequate 16 

Mixed 9 

TOTAL 60 

It is very significant that we are dealing with a group of girls who almost 
universallv present outstanding character defects and personality difficulties. 
TABLE 14— PRINCIPAL SOMATIC DISEASES AND DEFECTS 

Enlarged tonsils 11 

Heart conditions 4 

Clinical symptoms of tuberculosis . . 5 

Enlarged cervical glands 14 

Defective teeth 27 

Defective speech 2 

Defective vision 11 

Gonorrhea 5 

Clinical symptoms of syphilis 7 

Enlarged thyroid 5 

Enuresis 4 

TOTAL 95 



MENTAL HYGIENE SURVEY OF CINCINNATI 29 



Fifty-one of the 60 girls suffered from physical defect or disease or gave 
evidence of physical ill health. 



A TYPICAL PSYCHOPATHIC DELINQUENT 

The psychopathic delinquent is not a clear-cut type in the sense that the 
mentally defective or feebleminded delinquent is. Since there is frequently no 
intellectual defect in these cases, their identification is not always apparent 
to the layman. In order to illustrate the type, the following case history is given. 
While the case here described is not typical in all respects, still, there are 
certain features which serve to dramatize the difficulties that exist in connec- 
tion with the management and supervision of this type of case. 

Bertha's father and mother were married after her birth. On the father's side there 
is a history of insanity. Bertha's mother is described as a "feeble sort of person." The mother 
is a psychoneurotic individual, at one time she claimed that her throat was paralyzed and 
refused to eat. She later recovered as a result of "electrical treatments." 

Bertha first appeared in court after running away from home. At home she had been 
reprimanded for going with a girl whose influence was not of the proper sort. Bertha per- 
sisted in the relationship and finally left home in a temper. However, this was not the first 
time that Bertha had been a problem both at home and at school. She had been guilty of 
promiscuous sex relations while a student in High School. When she was caught after running 
away, she was sent to a maternity home because of a question of pregnancy. She was com- 
mitted by the court to the Girls' Opportunity Farm where she began to give trouble im- 
mediately. She grew very sullen and dissatisfied in the sewing room, her work was changed 
but she was not suited*. She grew pale and thin, would not get out of bed and had to be 
forced to take medicine. 

Next came a period of feigned insanity. She would furtively sneak through the house, 
take everything she could get her hands on, break loaves of bread in half and munch them 
like a wild animal. Upon being asked whether she was hungry she would say "no." In 
the sewing room she would cut up materials with no idea as to what she was going to 
do with them. 

She was scarcely recognizable, however, whenever she had a visitor; she was all life 
smiling, talkative and prompt. 

In order to see how she would react, she was told that she might be paroled. She im- 
mediately pulled herself together and appeared to be a normal girl. 

She was paroled, and from the moment she was released to her mother she began 
to "go the pace." She returned to her old companions and became such a problem that her 
family returned her to the Farm because they were absolutely unable to control her. 

After her return she ran away from the Farm on two occasions. On one of the very 
coldest nights, dressed in a nightgown and patent leather belt, with a string of green 
bonds around her neck she left the Farm. A motorist found her lying in the middle of the 
road, waving a large pair of shears in the air. When returned to the Farm she claimed 
to have been attacked by some men in an automobile. 

At present she is working comparatively well under supervision, but is a constant 
problem. She has periods of rage when she talks incessantly. She reviles her immediate 
family — calls them names although her charges are without foundation in fact. 

At the time of our examination she was found to be a well-developed girl of 17 years 
with no physical defects. She had reached the first year in High School. She was restless, 
hypersuggestible, impulsive and stubborn. Withal, she was rather frank and likable. She 
explained all of her peculiar activities in a manner which was, at least, satisfactory to her. 
She accounted for many of her acts by saying that she always got what she wanted by 
dramatizing the situation. 

Her mental age as measured by the Stanford Bevision of the Binet Simon tests was 19 
years, giving her an Intelligence Quotient of 118, which ranks her as being considerable 
above the average, intellectually. However, she showed marked defects of character with out- 
standing personality handicaps. A diagnosis of psychopathic personality was made and 
hospital observation recommended. 

A psychiatric social investigation was made in this case to determine what 
factors in the home and neighborhood environment might account in part for 
her career of misconduct. The method of scoring the homes and neighbor- 
hoods is described in the sections which deal with the psychiatric social 
investigation. It is only necessary to say here that the score represents the 
social status of the home, taking into account the various elements which go 
to make up satisfactory conditions. Bertha's home received a total score of 
10 as follows: necessities, 3; neatness, 2; size, 3; parental conditions, 1; parenta] 
supervision, 1. The neighborhood in which Bertha's home is located scored ). 



30 MENTAL HYGIENE SURVEY OF CINCINNATI 

A perfect score in both cases would be 25 and any score under 13 represents 
very unfavorable conditions for the best interests of the child. Analysis of 
this home score shows important facts. Both parental conditions, that is, the 
degree of harmony between the parents, their social adaptability and intelli- 
gent parental supervision and control receive the lowest possible score. 

THE BOYS' OPPORTUNITY FARM 

Like the Girls' Opportunity Farm, the Boys' Opportunity Farm receives 
its cases exclusively through commitment by the Juvenile Court. The Farm 
is located at Glendale, Ohio, on a tract of 200 acres of land. The cottage plan 
of housing is used, there being four cottages besides the superintendent's resi- 
dence. The farm is under the supervision of the Department of Public Safety 
of the City of Cincinnati, and receives delinquent boys between the ages of 
10 to 18 years, committed by the court. 

The Cincinnati Board of Education furnishes teachers for the academic 
and manual training of the boys at this institution. The boys spend approxi- 
mately one-fourth of their time in shop work and in receiving vocational train- 
ing, incidental to their activities on the farm and in the dairy. 

The colored boys are segregated from the white boys, and the older from 
the younger boys. A housemaster lives in each cottage. Contagious cases are 
sent to the City Hospital. Regular medical examination and treatment are 
given by a physician at the City Hospital. 

GENERAL ANALYSIS OF THE DATA GATHERED DURING SURVEY 

At the Boys' Opportunity Farm we have a group that is analogous to the 
group at the Girls' Opportunity Farm in that it deals with mid-adolescent 
delinquents whose delinquency is of so serious a character as to make neces- 
sary their removal from the community. In most cases probation methods 
have proven inadequate. There were 68 cases studied. Practically all were 
native born, there being only one foreign boy at the farm. The great majority 
of the native-born whites also had native-born parents. 

There were 29 negro and 39 white boys. 

The chronological ages were distributed between 9 and 20 years. The 
median chronological age was 14 years and 3 months; more than half of the 
cases were between 13 and 16 years of age. 

Forty-eight of these boys were repeated offenders; some had been in 
court as many as ten times before. The average number of offences of each 
boy was more than 3. Sixty-three individuals gave a previous history of 
behavior difficulties, having shown conduct disorders such as truancy, lying, 
stealing, fighting, etc., for some time previous to their court appearance. 

TABLE 15— AMOUNT OF SCHOOL RETARDATION 

Normal school progress 6 

Retarded 1 year 8 

Retarded 2 years 13 

Retarded 3 years 9 

Retarded 4 years 15 

Retarded 5 years 11 

Retarded 6 years 5 

Retarded 7 years 1 

TOTAL 68 

It will be noted that almost half of the cases were retarded in school four 
or more years. The psychological tests showed that the median mental age 
is 10 years and 6 months, while the median chronological age is 14 years and 
3 months. Table 16, showing mental diagnosis, is very significant: 



MENTAL HYGIENE SURVEY OF CINCINNATI 31 

TABLE 16— MENTAL DIAGNOSIS OF BOYS CLASSIFIED ACCORDING 
TO RACE AND PARENTAGE 



Diagnosis Total 

Normal 1 11 

Subnormal 8 

Mental defect 2 30 

Psychopathic personality 15 

Other diagnoses 4 



Native-born White 



Native 


Foreign 


Negro 


Parentage 


Parentage 




7 




4 


2 


1 


5 


11 


4 


15 


9 


3 


3 


1 


1 


2 



TOTAL 68 30 9 29 

1 Includes dull normal. 

3 Includes borderline mental defect. 

Only 11 cases out of 68 were classed as "normal." For ease of presentation 
the borderline mental defectives and the feebleminded were classed together 
though a certain percentage of these former cases did not show sufficient 
evidence of mental defect to warrant our calling them feebleminded. Physical 
condition is shown in table 17. 

TABLE 17— PRINCIPAL SOMATIC DISEASES AND DEFECTS 

Defective vision 10 

Enlarged cervical glands 39 

Enlarged tonsils 23 

Heart conditions 7 

Clinical symptoms of tuberculosis 5 

Defective teeth 27 

Clinical symptoms of syphilis 4 

Defective speech 5 

Gonorrhea 2 

TOTAL 122 

Sixty-one of these boys had some physical defect or disease, or showed 
some disturbance in physical health. 



ADULT DELINQUENCY 

The adult delinquent was studied in connection with the Ohio Humane 
Society and the county jail. 

THE OHIO HUMANE SOCIETY 

This organization occupies a position midway between the courts and 
institutions on the one hand, and a private ameliorative agency on the other. 
It serves in a large measure as a probation department; it is semi-official, and 
is partly financed from public funds. Originally it was an organization for 
the prevention of cruelty to animals, but this has become a minor part of its 
activities. It is in reality an agency for the prevention of cruelty to children, 
a prosecuting agency in the case of failure to provide on the part of a delin- 
quent husband or father, and it looks after the interests of mother and 
child in illegitimacy cases. It investigates and prosecutes cases in which 
there are improper home conditions surrounding minor children and under- 
takes the protection and placement of these children when it is necessary to 
break up a home. By order of the court, thousands of dollars every year are 
paid through this agency to the support of dependent families by deserting 
husbands. 

Not all of the cases handled by the Ohio Humane Society present problems 
in delinquency. However, they all involve some sort of social maladjustment. 



32 MENTAL HYGIENE SURVEY OF CINCINNATI 

In its preventative work this society comes in contact with a large group of 
people who might be termed pre-delinquent, although rather infrequently does 
the society deal with what is popularly termed "crime." All of its problems are 
behavior problems, and thus fall well into the scope of this phase of our report. 

STAFF 

Some interesting departures from ordinary procedure are indicated by the 
personnel of this organization. Two police officers and two officers with 
police authority are assigned to duty with the Ohio Humane Society. The 
society has entire direction and control of these officers. This arms it 
with police power and greatly facilitates the handling of its delinquent cases. 
Except for the fact that they are in uniform, these officers are in no way 
different from the regular case investigators on the society's staff. They have 
become trained social workers. The remainder of the staff consists of three 
visitors, and an executive secretary, a director of case work, and several 
clerical assistants. The utilization of police officers in this type of work is a 
very significant experiment in the socialization of the policeman. The success 
that has attended this venture indicates the possibilities in properly training 
and directing policemen in the prevention of crime. 

ANALYSIS OF DATA GATHERED 
One hundred cases were studied, taken in the order in which they appeared 
at the society's offices. Not all of these persons were delinquent individuals — 
for instance, a deserted wife might make a complaint against her husband. 
However, the object was to get a picture of what sort of persons are dealt 
with by this organization, whether they were actually delinquent or not. 
Consequently, a "run-of-the-mine" for a definite period was studied. The 
following table gives an idea of the classification of the cases that is used 
by the Ohio Humane Society. 

TABLE 18— TYPES OF CASES 

Unmarried mother 10 

Failure to provide for child 69 

Failure to provide for parent 8 

Improper home 5 

Cruelty 2 

Incompatability 4 

Child placement 1 

Incorrigible child 1 



TOTAL 100 

Sixty-five persons were native whites of native-born parents; 20 were 
negroes;' 8 were native whites of foreign-born parents; and 7 were foreign- 
born whites. 

In age these individuals ranged from 14 to 79 years. The median chrono- 
logical age was 24.6 years. Seventy-six of the 100 cases were females and 24 
were males. 

Sixty-one gave no history of past behavior difficulties; 39 gave a history 
of sex promiscuity, gambling, stealing, fighting, drinking, etc. 

The following table shows the mental diagnosis according to sex and color: 
TABLE 19— MENTAL DIAGNOSIS 
Mental Diagnosis Total 

Normal 34 

Subnormal 9 

Borderline mental defect 12 

Feebleminded 26 

Psychopathic personality 8 

Epilepsy 3 

Mental disease 8 



* r hite 


Negroes 


Male 


Female 


29 


5 


9 


25 


7 


2 


1 


8 


6 


6 


3 


9 


21 


5 


3 


23 


7 


1 


3 


5 


2 


1 


1 


2 


8 





4 


4 



TOTAL 100 80 20 24 76 



MENTAL HYGIENE SURVEY OF CINCINNATI 33 

Sixty-six of the cases showed some deviation from normal mental health 
or intelligence. Twenty-six of these individuals were feebleminded, while 
eight were suffering from mental disease. This is a striking statement of mental 
conditions and shows that any program for meeting the problems these indi- 
viduals present to the Ohio Humane Society is certainly limited without a 
proper mental diagnosis of each individual. The very foundation of all 
efforts at adjusting these persons must be based upon a knowledge of the indi- 
viduals themselves. 

The physical condition is shown in the following table. Of course, this by 
no means represents the true picture of the great variety of medical problems 
presented by each one of these individuals. It is merely a record of certain 
outstanding conditions recorded by the examiners. 

TABLE 20— SOMATIC DISEASES AND DEFECTS 

Enlarged thyroid 9 

Syphilis 1 

Underweight 1 

Defective vision 12 

Defective hearing 2 

Diseased hip joint 1 

Heart conditions 2 

Anemia 1 

Tuberculosis 3 

Speech defect 5 

Endometritis 1 

Perineal tears 1 

Defective teeth 7 

Hernia 3 

Adenoids 1 

Arterio-sclerosis 1 

Vaso-motor angina 2 

Diseased tonsils 3 

None reported 57 

Forty-three of these individuals suffered from some physical defect or dis- 
ease, or gave evidence of some physical ill health. 

ILLUSTRATIVE CASES 

Tillie, colored, was examined at the Ohio Humane Society. She was 25 years old and 
claims to have reached the third year in High School. Tillie's father had heen arrested on 
several occasions for cruelty to his family and he had finally deserted them. Tillie's mother 
had died two years before our examination, and Tillie had been cut adrift with $900 in cash 
which her mother had saved after years as a laundress. 

Examination revealed that Tillie was in good general physical condition. She gave a 
history, however, of periodic convulsive seizures which further investigation warranted diag- 
nosing as epilepsy. These attacks had occurred since Tillie was a little girl. Her mother 
had always told her they were "fits." During the attacks Tillie became quite unmanage- 
able, bit, scratched, and at times had unconscious attacks during which she bit her tongue. 
Her mental age was only 8 years. 

All had gone fairly well with Tillie until her mother's death. Cut loose from any sort 
of protection at that time, and with $900 in money, Tillie began to get into difficulties. 
She made some effort at work — was an usher in a motion-picture theatre, where an attack 
caused her to be promptly discharged; ran an elevator until another seizure again resulted in 
her discharge. Two years after her mother's death found her at the Ohio Humane Society 
penniless and about to become an unmarried mother. Tillie did not know which of several 
men was the father of her child. In fact, she did not greatly care if some one of them 
could be forced to support it. She evinced no concern regarding her periodic seizures — 
they had become a habitual thing in her life. She was talkative, superficial, and rather vain. 

This girl, handicapped mentally and physically, was cast adrift in the community 
in no way equipped to manage her affairs, suffering from a mental condition that made 
an industrial life practically impossible. The outcome was- to be expected and might have 
been predicted at a much earlier period in her career. 

THE CASE OF MAGGIE 

The following case indicates some of the difficult problems presented by the individuals 
with whom the society comes in contact: 

Two years ago Maggie's one child, a baby of three years, had been taken from her 



34 MENTAL HYGIENE SURVEY OF CINCINNATI 

because Maggie was a "known prostitute." The child was illegitimate, and although frequently 
attempts had been made to rehabilitate Maggie, she had resisted all overtures and seemed 
utterly indifferent to the fate of the child. The Ohio Humane Society had by legal procedures 
taken the child and placed it in another home. For a time the society kept some track of 
Maggie, finally she disappeared from sight and the case was placed in the "closed" file. 

Two years later Maggie suddenly appeared at the society's offices and demanded to see 
the executive secretary. An interview Avas given and Maggie stated that for the last six 
months she had been "going straight," had been living with her father and mother and had 
permanently abandoned evil ways. She said that about a year before she had become con- 
verted by a religious revivalist and was endeavoring to atone for her sins. She now felt that 
she was sufficiently re-established on the straight path to undertake her responsibilities in 
regard to her illegitimate child. She appeared to be absolutely sincere. She was moderately 
well dressed, although she still bore some evidences of her former dissipation. She was living 
with her parents and they were known to be self-respecting people of moderate means. 
Although they had never been able to control her previously, it appeared she was telling the 
truth when she said that she had been living a very quiet life for at least six months at home. 

A very puzzling situation was presented. The child which had been placed in a very 
superior home was doing excellently. The foster parents were providing the child a home 
that was very much above the average. On the other hand, Maggie passionately insisted on 
having the child return to her and gave every evidence that she was rehabilitated in the world. 
The father and mother backed their daughter's plea. There was something in Maggie's manner 
that impressed the case worker as being peculiar. Perhaps it was a certain strained note 
which was not entirely accounted for by the fact that Maggie was a mother seeking for 
the return of a child. At any rate a mental examination was requested. A cursory study of 
the social history revealed the facts as they have been stated. However, gentle probing drew 
out some additional material. Maggie became quite emotional over questions regarding her 
religious experiences. She stated that she had first "gone bad" at the death of her brother 
when she was 14 or 15 years of age. She had been much attached to this brother, and although 
it was many years since his death, she burst into tears at the mention of his name. She 
stated that this dead brother now appeared to her at regular intervals and that she was 
acting upon his instructions in asking for the return of her child. Her religious experience 
was the result of instructions from this dead brother and her whole life since then was an 
"atonement" to him. She felt that he watched her constantly and was commanding her 
"to do right." A psychiatric social investigation revealed that Maggie's mother, a woman with 
marked repressions, also held communion with this brother. Her life was largely tied up 
with the brother who had long been dead. Maggie and her mother believed absolutely in 
the reality of this brother's appearance and were hinging their lives very largely around him. 
Maggie's mental condition was such as to justify a period of hospital care and treatment. 

The work being done by this organization deserves the very highest 
approval. If this particular group of cases in any way represents a picture of 
the problems dealt with, then it is obvious that, before efforts are made at 
treatment and social adjustment, a large proportion of the "run-of-the-mine" 
should receive the most careful and thoroughgoing physical and mental 
examination. 

HAMILTON COUNTY JAIL 

The Hamilton County Jail occupies the top floor of the Court House. The 
treatment of the prisoners is humane in character. However, a criticism may 
be offered which fits well the situation as presented by the jails and that is as 
to the lack of profitable employment and training of prisoners. The jail 
and the workhouse are combined, and the workhouse prisoners are employed 
at the Cincinnati General Hospital, the city water works, laundry, kitchen, 
bakery and in keeping the jail clean. However, many prisoners have no 
employment — many of them serve sentences for months in absolute idleness. 
It is a most vicious system that permits of the long-continued idleness of 
criminals in jail. In a way we are contributing to further crime by such 
methods. The prisoners are segregated as to sex, and an effort is made to 
separate young offenders from older ones. 

Insane prisoners may be detained in jail awaiting commitment. There 
were two insane at the time of our study. There is no machinery for detect- 
ing those who develop insanity while awaiting trial or while serving sentences. 

The health of the prisoners is looked after by an attending physician, who 
comes each day and treats those who are sick. There is no routine physical 
examination, and hospital facilities are inadequate. 

ANALYSIS OF MATERIAL GATHERED 

An unselected group of 200 cases was studied at the county jail in the order 
of their appearance on the official ledgers. This group represents about one- 
tenth of the total number of individuals who pass through the jail in a year 
There were only four females in this particular group studied. 



MENTAL HYGIENE SURVEY OF CINCINNATI 



35 



One hundred and three were white and 97 were black. 

Of the white, 56 were native born. 

The ages ranged from 18 to 79 years, the largest proportion being between 
the ages of 20 and 29 years. 

Table 21 gives some idea of the offences for which these individuals 
were detained in jail. 

TABLE 21— OFFENSES 

Group Actual Offense Number 

Disorderly Conduct — 

Disorderly conduct 10 

Loitering 5 

Traffic violation 2 

Gambling 2 

Carrying concealed weapons 3 

TOTAL 22 

Violence — 

Shooting to kill 11 

Cutting 2 

Fighting 2 

Assault and battery 11 

Murder 8 

TOTAL 34 

Fraud — 

Transportation of auto 2 

Embezzlement 3 

Forgery 6 

Receiving money under false pretences.. 9 

Selling and receiving stolen goods 3 

Defrauding inn keeper 1 

Conversion of personal property 2 

Raising bill 1 

TOTAL 27 

Theft- 
Grand larceny 17 

Petit larceny 14 

Pocket picking 4 

Burglary 8 

Robbery 16 

House breaking 5 

Stealing auto 5 

TOTAL 69 

Sex- 
Rape 4 

Contributing to juvenile delinquency 5 

Bigamy 1 

Keeping disorderly house 1 

Sodomy 1 

Violating Mann Act 2 

Exposing person 2 

TOTAL 16 

Miscellaneous — 

Violating prohibition laws 14 

Lunacy 1 

Illicit sale and possession of narcotics. . . .10 

Failure to provide for family 6 

Draft evasion 1 

TOTAL 32 



36 MENTAL HYGIENE SURVEY OF CINCINNATI 

Sixty-three per cent of these individuals were repeated offenders. Seventy- 
nine per cent gave a history of past disorders of conduct such as the following: 
stealing, fighting, sex delinquencies, sex perversions, drug addiction, alcoholism, 
lying, vagrancy, gambling, etc. (Ten cases were drug addicts.) 

Of this group showing past behavior difficulties, four out of every five 
were handicapped by some very definite mental abnormality. 

Sixty and five-tenths per cent never got further than the fifth grade in 
the public schools. This includes 12 per cent who never attended school and 
4 per cent who attended less than one year. Studying their school record, 
it may be interesting to note that 55 per cent, while in school, had been 
retarded four or more years. 

Only three per cent were skilled workers. 

Forty-seven per cent of these cases had never been married. 

TABLE 22— MENTAL DIAGNOSIS 

Diagnosis Total White Negro 

Normal 51 35 16 

Subnormal 27 14 13 

Borderline mental defect 14 7 7 

Feebleminded 57 6 51 

Psychopathic 36 30 6 

Psychoneurosis 7 6 1 

Mental disease 4 3 1 

Epilepsy 2 1 1 

Undiagnosed 2 1 1 

TOTAL 200 103 ~~97 

Seventy-four and five-tenths per cent of these individuals were classified 
as either subnormal in intelligence of borderline mental defect, mentally 
defective, suffering from a psychoneurosis, a psychopathic personality, mental 
disease or epilepsy. More than half of the negroes were classified as mental 
defectives, while only 5.8 per cent of the white were called feebleminded. 
Twenty-nine and one-tenth per cent of the native whites were classified as 
psychopathic while only 6.2 per cent of the negroes were so classified. 

Seventy-seven per cent of these jail inmates were handicapped by per- 
sonality difficulties and character defects to a very marked degree. 

It may be remarked that 63.5 per cent of the first offenders were classified 
as either subnormal in intelligence, feebleminded, mentally diseased, suffering 
from epilepsy, psychoneurosis, or psychopathic personality, while 82 per cent 
of repeated offenders were so handicapped. There are nine times as many 
psychopaths amongst those who have been arrested five times as amongst the 
first offenders. It is interesting also to note that, taking the repeated offenders 
as a group, we found that 40.5 per cent were diagnosed as mental defectives. 

Forty-one cases admitted that they had been arrested for the first time 
before they were 19 years of age. More than half of all these jail inmates 
admitted that they had records of arrest before they were 24 years of age. 

Forty-four per cent of these jail inmates were suffering from some marked 
physical defect or disease or physical ill health. 

THE UNMARRIED MOTHER 

Illegitimacy and unmarried motherhood are ever-present problems that 
face practically all types of case-working social agencies. Before the birth of 
the child, the mother presents a problem in health, and later there is the 
question of her rehabilitation in the community and the placement of her 
child. Our present study does not attempt to cover the whole field. However, 
the mental hygiene aspect of illegitimacy and those mental factors that play 
so important a part in all types of sex delinquency, cannot be over-emphasized. 
Mental hygiene is concerned with the kind of individual who gets into social 
and legal difficulties. 



MENTAL HYGIENE SURVEY OF CINCINNATI 37 

The cases represented in this study were examined at the Ohio Humane 
Society, the Home for the Friendless and the Catherine Booth Maternity Home. 

The Ohio Humane Society probably more than any other case-working 
agency comes in contact with illegitimacy. The chief concern of this society 
is the placement of the child and the rehabilitation of the mother. The Home 
for the Friendless and the Catherine Booth Home are maternity hospitals, and 
their chief concern is the health of the mother before and after the birth of 
the child, and the health of the infant. 

ANALYSIS OF MATERIAL GATHERED 

Of the seventy cases studied, 11 were negroes and 59 were white. Forty- 
eight of the white persons were native born of native-born parents. 

The ages ranged from 18 to 40 years. The median chronological age was 
19.4 years, and over half of the cases lay between the ages of 17 and 19 years. 
With the major portion of the cases under 20 years of age, it is evident that 
we are dealing with adolescent girls. Not only this, but the majority of these 
girls were from small country towns while 29 came from definitely rural 
neighborhoods. Only six girls had ever been arrested. 

Approximately 22 of these girls never got further than the fifth grade in 
school, although 15 girls had completed the grammar grades and nine were in 
high school, while one had gone to normal school. 

Twenty of the girls admitted having been sexually promiscuous, while 40 
of them denied any previous sex experience. 

TABLE 23— MENTAL DIAGNOSIS 

Mental Diagnosis — Total White Negro 

Normal 20 18 2 

Subnormal 10 7 3 

Borderline mental defect and feebleminded 28 24 4 

Psychopathic personality 7 7 

Psychoneurosis 3 3 

Epilepsy 2 2 

TOTAL 70 59 11 

Only 20 of these girls were classified as normal. About two-thirds of the 
girls who admitted to being sexually promiscuous were diagnosed as mental 
defectives, while only one-third of the girls who gave no history of previous 
sex experience were called mental defectives. 

Twenty-eight were classified as being either cases of borderline mental 
defect or feebleminded. 



COMBINED SUMMARY, BOYS' AND GIRLS' OPPORTUNITY 

FARMS, INDIVIDUALS STUDIED AT OHIO HUMANE 

SOCIETY, THE UNMARRIED MOTHER GROUP, 

AND HAMILTON COUNTY JAIL INMATES 

SUMMARY OF GIRLS' OPPORTUNITY FARM 

There were 60 girls at the Farm, each of whom received a physical, mental, 
and social diagnosis. 

The median chronological age for the group was 16 years. Forty-four were 
between the ages of 15 and 17 years. 

Twelve and four-tenths years was the median mental age, while 15 girls 
had a mental age of 10 years or under. 

Fifty-four of these girls were retarded one or more years in their school 
work. 



38 MENTAL HYGIENE SURVEY OF CINCINNATI 

Eighteen were repeated offenders. Of those appearing in court more 
than once, approximately half were diagnosed as psychopathic personality. 

A history of previous conduct disorders was obtained in the case of 
55 of the girls. 

Only eight of the girls were diagnosed as normal; 24 of them were 
diagnosed as psychopathic; 13 were diagnosed as cases of borderline mental 
defect and feeblemindedness. ' 

Fifty-one of the girls suffered from some physical defect or disease or gave 
evidence of physical ill health. 

SUMMARY OF BOYS AT BOYS' OPPORTUNITY FARM 

There were 68 cases studied, practically all of whom were native-born. 
There was only one foreign-born boy. Twenty-nine were negroes and 39 were 
white boys. 

The median chronological age was 14 years and 3 months. More than 
half of the cases were between 13 and 16 years of age. 

Forty-eight of the boys were repeated offenders; many had been arrested 
as many as ten and some 15 and 20 times. 

Histories gathered showed that 63 of these boys had shown previous con- 
duct disorders. 

Almost half were retarded four or more years in school. 

The psychological tests showed that the median mental age was 10 years 
and 6 months. 

Only 11 cases were diagnosed as "normal;" 30 boys were classed as either 
borderline mental defect or feebleminded; 15 boys were diagnosed as psycho- 
pathic personality. 

Approximately 61 showed some physical defect or gave evidence of 
physical disease or physical ill health. 

SUMMARY OF ADULT DELINQUENCY 
Ohio Humane Society 

While this organization does not deal altogether with delinquent cases, still 
the character of problems presented for study could best be grouped undjer 
this heading. Out of 100 cases studied, being the "run-of-the-mine," ten were 
unmarried mothers, 69 were individuals who had failed to provide for their 
children, eight had failed to provide for a parent, five were cases of improper 
home, two of cruelty, four of incompatability, one of child placement, and one 
was an incorrigible child. 

Sixty-five persons were native-born whites of native parents, 20 were 
negroes, 8 were native whites of foreign-born parents, and 7 were foreign- 
born whites. 

The ages varied from 14 years to 79 years. Seventy-six of the 100 cases 
were females and 24 were males. 

Thirty-nine gave a history of socially unacceptable conduct, including sex 
promiscuity, gambling, stealing, fighting, drinking, etc. 

Sixty-six of these individuals showed some deviation from normal mental 
health or intelligence, 26 were feebleminded, eight were suffering from mental 
disease. 

Certainly any program for meeting the problems these individuals present 
to the Ohio Humane Society will fall short of accomplishment without a proper 
mental diagnosis in each individual case. 

Forty-three of these individuals suffered from some physical defect or 
disease or gave evidence of physical ill health. 

Hamilton County Jail 

An unselected group of 200 cases were studied at the county jail in the order 
of their appearance on the official ledger. This group represents about 
one-tenth of the total number of individuals who pass through the jail in a 
year. There were only four females in the group studied. One hundred 
and three were white and 97 were negroes. 



MENTAL HYGIENE SURVEY OF CINCINNATI 39 

The ages ranged from 18 to 79 years. The largest proportion being 
between the ages of 20 and 29. 

Sixty-three per cent of these individuals were repeated offenders. 

Sixty and five-tenths per cent never got further than the fifth grade in the 
public schools. 

Only three per cent were skilled workers. 

Forty per cent of the cases had never been married. 

Seventy-four and five-tenths per cent were classified as either subnormal 
in intelligence, of borderline mental defect, mentally defective, suffering from a 
psychoneurosis, psychopathic personality, epilepsy or mental disease. More 
than half of the negroes were classified as mental defectives, while only 5.8 
per cent of the whites were called mental defectives. Twenty-nine and one- 
tenth of the native whites were classified as psychopathic personality, while 
only 6 per cent of the negroes were so classified. 

" Seventy-seven per cent of these jail inmates were handicapped by person- 
ality difficulties and character defects to a very marked degree. It may be 
remarked that 63.5 per cent of the first offenders showed some evidence of 
nervous or mental abnormality while 82 per cent of the repeated offenders 
could be clearly classified as suffering from marked deviations from normal 
mental health. 

Almost half of the cases admitted that they had been arrested for the 
first time before they were 19 years of age. 

Forty-four per cent of these jail inmates were suffering from some marked 
physical defect or disease or gave evidence of physical ill health. 

The Unmarried Mother 

A group of 70 was studied. Eleven were negroes and 59 were white girls. 
Forty-eight of the white girls were native born of native-born parents. The 
ages ranged from 18 to 40 years. 

The median chronological age was 19.4 years. 

Approximately 22 of these girls never got further than the fifth grade in 
school. 

Twenty of the girls admitted to having been sexually promiscuous, while 
40 denied any previous sex experience. 

Ten girls were classified as subnormal, 28 as cases of borderline mental 
defect or feeblemindedness. There were seven cases of psychopathic person- 
ality, three of psychoneurosis and two of epilepsy. Only 20 girls out 
of the group did not show some very marked mental abnormality. 



DISCUSSION OF DELINQUENCY 

We cannot speak too highly of the splendid work being done by the 
Juvenile Court of this city, in dealing with the problem of juvenile delin- 
quency. This court has received nation-wide attention because of the splendid 
work it is doing. With it all, Judge Hoffman feels that his machinery is but 
poorly equipped to handle effectively the complex problems that present them- 
selves daily to his court. 

It is quite clear from this survey that the most imperative need of the 
court is to be found in connection with its clinical equipment. This is most 
incomplete, as Judge Hoffman himself feels. A full-time psychiatrist and a 
highly trained psychiatric social worker are urgently needed. This, we believe, 
could be better taken care of through a central psychiatric clinic for the city as 
mentioned later on in the report. 

In approaching the problem of adult crime, we hardly know what to say. 
We can state very definitely, however, our convictions that in this direction 
Cincinnati is not to be envied. The modern methods that have stood the test 
of years of experience in many cities throughout this country have not yet 
reached Cincinnati. Adult probation is in its infancy here, and there are 



40 MENTAL HYGIENE SURVEY OF CINCINNATI 

practically no facilities whatever for recognizing insane criminals, or feeble- 
minded, epileptic and psychopathic criminals who are a menace to the general 
public and form the very backbone of chronic recidivism through repeated 
criminal conduct. 

In all, we have studied 655 cases. Fifty-one per cent of these individuals 
were repeated offenders, persons who had been in court time and time again; 
persons who had repeatedly served sentences in institutions; persons who had 
behaved in a way at variance from average normal behavior and where behav- 
ior had expressed itself in criminal conduct from childhood. This is a serious 
challenge to our methods of dealing with criminals. It has been estimated 
that crimes by men with prison records outnumber crimes by other offenders 
more than 40 per cent. 

The whole question of sentencing either juvenile or adult offenders for 
definite periods of time, is not based on common sense. It is pure guess work 
to try to say whether a man can reform in a given time. Our attitude of 
dealing with criminals is still in a large measure one of vengeance. It is a fact 
that we take little account of individual differences, and of the causes that lead 
an individual to commit criminal acts. We are still held down by the old con- 
ceptions of criminal law and of criminal responsibility. If a man is sane, then 
he must be responsible and should be punished if he breaks the law. 

Sentencing criminals to penal and correctional institutions for limited 
periods without any reference to the causes for their criminal conduct — causes 
found within the individuals themselves as well as in their environments — and 
without any reference to the needs of the individual offender, if he is to be 
reformed and lead a normal life, is in the same category with sending sick 
people to hospitals and giving them nothing more than kindly and humane 
treatment, sanitary surroundings, good food, and then turning them out at 
the end of an arbitrary period without any reference to whether their illnesses 
have been improved or not. 

It is believed that success in the handling of criminals and in the preven- 
tion of crime will depend on the degree of interest we take in developing 
methods for dealing with delinquent persons as individuals, and not as groups; 
for determining the causes of their delinquent behavior and for setting in 
motion machinery looking towards the eradication of these causes and the 
rehabilitation and readjustment of the individual offender. 

The methods mostly in use today for dealing with criminals do not give us 
a knowledge of the individual criminal himself, and why he acts as he does 
and yet there is ample evidence in many fields that scientific methods of inquiry 
have already been developed to a sufficient degree to enable us to ascertain the 
causes for the failures of certain persons to conduct themselves as they 
should. 

These methods have been applied in many places in dealing with criminals 
and haxe resulted in great improvement in the treatment and prevention of 
crime. 

It is believed that the application of scientific methods of investigation to 
the study of every offender, every criminal, before disposition in court, and the 
mapping out of a plan of treatment in the light of this careful and comprehen- 
sive inquiry, would result in a great reduction in crime. 

If this is our purpose, if the aim in view is to protect society and prevent 
criminal conduct, then we need to get away from philosophical theories and 
face the facts; we need to think less of responsibility and punishment, of 
wreaking vengeance on the wrong doer, and to learn more about what sorts 
of persons commit crime and why they commit crime and, in the light of 
this, what needs to be done to give the greatest protection to society, on the 
one hand, and to prevent future criminal careers on the other. 

Every court should be equipped with clinical facilities for making physical, 
mental and social diagnoses. There should be an ample and well-trained pro- 
bation staff to carry out treatment, supervision, and social adjustment of all 
individuals who can be handled with safety in the community. Through 



MENTAL HYGIENE SURVEY OF CINCINNATI 41 

such methods the saving of expense will be immense, and real steps will be 
taken in the prevention of crime. 

Penal and delinquent institutions should be organized to carry on in an 
effective way the education, trade training and physical and mental recon- 
struction of such offenders as are sent to them, or to segregate permanently 
those who cannot be returned with safety to the community. 

It has now come to be recognized that the great majority of all criminal 
careers begin in childhood. The most striking thing in the recent crime wave 
in this country, is the great frequency of crimes of violence committed by very 
young offenders. 

Early, even in the pre-juvenile court age, manifestations of conduct dis- 
orders show themselves. Conditions are apparent in public-school children 
that lead later on to gross criminal behavior. This particular survey shows 
that approximately six per cent of the public school children showed unac- 
ceptable conduct of such a nature as to have come frequently to the attention 
of school authorities. We call attention to this important fact that the danger 
of entering upon criminal careers is one of the most serious conditions 
threatening childhood. These matters may not be regarded lightly. If we are 
to take serious measures to prevent crime, there is no period so opportune 
as that of the public school age. The criminals of the future, it is believed, 
will be drawn mostly from the children who show marked conduct disorders 
in the public schools. 

Proper clinical facilities for the study of the complex behavior problems 
found in public school children should be provided. The unravelling of each 
individual problem will require the most expert service. Personal difficulties, 
unhealthy mental adaptations, mental conflicts, improper home background, 
nervous and psychopathic parents, bad sex practices and teachings of older 
children, grave physical disorders, poorly arranged curriculum and a great 
variety of conditions will be found entering as causative factors in every case. 

In short, if this study of delinquency shows anything at all, it shows that 
the city of Cincinnati is in need of a central psychiatric clinic that will serve 
the public schools in dealing with the conduct disorders that cannot be han- 
dled through the Vocation Bureau, that will serve the Juvenile Court, and — 
what is of the most urgent consideration in this city at present — will assist in 
handling the medical and psychological problems of the Municipal Court. Such 
a clinic will also serve for classification purposes as w T ell as giving advice 
to all delinquent institutions and agencies dealing with delinquent individuals. 



DEPENDENCY 
JUVENILE DEPENDENCY 

The dependent child was studied in the following agencies and institutions: 

1. The Children's Home 

2. The General Protestant Orphanage 

3. The Bureau of Catholic Charities 

4. Boarding Homes 

Three hundred and fifty-nine children were examined in the institutions 
listed above. There are other agencies and institutions in Cincinnati that deal 
with dependent children, but the agencies named give a fair picture of the situ- 
ation as it exists in orphanages and placement agencies. 

The Children's Home is primarily a placement agency existing for the pur- 
pose of placing "homeless children in childless homes and of rendering tempo- 
rary emergency relief to homeless children." The main building of the home is 
in the center of Cincinnati, and the branch home is located in an outlying 
suburb. The latter consists of attractive modern cottages built on a small farm 
acreage. In the central home a day nursery is conducted. The turnover of 
the children is very rapid; and it is not the object of the home to give perma- 



42 MENTAL HYGIENE SURVEY OF CINCINNATI 

nent custodial care to its wards, but to place them in foster homes. The 
equipment, personnel, and general atmosphere of the home are excellent. 

The General Protestant Orphanage is one of the oldest and most con- 
servative of the child-custodial institutions in Cincinnati. It is located near 
the center of the city and exists for the care of "dependent orphans and half 
orphans." Very little placement work is done, and the institution is primarily 
a custodial agency of the old-fashioned orphanage type. The equipment is 
fairly well adapted to the needs of an institution of this sort. This institution 
is neither better nor worse than the average orphanage where children are 
dealt with en masse. 

The children studied at the Bureau of Catholic Charities were part of 
the family-relief problem with which this agency deals. The description of 
this agency will be found in the section dealing with adult dependency. 

In the boarding homes we have a newer method of approach to our 
problem. A committee on boarding homes supervises the Boarding Homes 
Bureau, which undertakes the investigation, placement, and supervision of 
children in private homes. The boarding-home mother is paid by the bureau 
for the care of one, two or three children. Each home receives regular super- 
visory visits by a representative of the bureau. These homes are carefully 
selected, and such factors as the personality and attitude of the boarding- 
home mother and the physical equipment of the home are carefully weighed 
before any child is placed. If the boarding home falls below the standard 
at any time, the child is immediately removed. In these boarding homes we 
have the same type of child that is ordinarily placed in a child-caring institu- 
tion. 

ANALYSIS OF MATERIAL GATHERED 

One hundred and forty-eight children were examined at the Children's 
Home, 123 at the General Protestant Orphanage, 41 at the Bureau of Catholic 
Charities, and 47 in the boarding homes. The boarding-homes children were 
brought to the examiners at the Council of Social Agencies Building. 

These 359 children came in the vast majority of cases from native-born 
parents. Only five negro children were examined. Two of these were classed 
"normal." The ages varied from 5 to 18 years, the median chronological age 
being 10.3 years. 

Thirty-two and three-tenths per cent were retarded in school from 2 to 
8 years. Many of them, given proper training along manual, industrial, 
and vocational lines, can be made self-supporting. By investing a small amount 
in their education now, a large amount can be saved from their support in 
later years. Of course, some few will be wards of the state as long as they 
live. 

Thirty-five and nine-tenths per cent were at the grade in school that is 
normal for their age in Cincinnati; while 50.1 per cent were retarded and 
10.3 per cent were advanced. Many factors must be taken into consideration 
in explaining this. While the mental capacity of the child, as will be shown 
later on, is highly important, yet these dependent children are often retarded 
for various economic reasons, many having been kept out of school in order 
to help support the family. Including the one year retarded and the one year 
advanced with the "at grade" group, we have 278, or 77.4 per cent, of the 
359 children close enough to the city norm to be classed as average in 
intelligence. 

TABLE 24— MENTAL DIAGNOSIS 
Mental Diagnosis Number Per Cent 

Normal 247 68.8 

Subnormal 46 12.8 

Borderline mental defect 24 6.7 

Feebleminded 12 3.3 

Psychopathic personality 26 7.2 

Psychoneurosis 3 0.8 

Epilepsy ^__L 0.3 

Total, 359 100.0 



MENTAL HYGIENE SURVEY OF CINCINNATI 43 

Sixty-eight and eight-tenths per cent of the children were classified as 
"normal." Our percentage of normal mentality is much higher in this group 
than in the delinquent group. In the delinquent group, approximately two- 
thirds of the total number of cases were classified in terms of mental malad- 
justment or abnormality; while in the dependency group only 31 per cent 
can be so classified. 

Some interesting comparisons between the children handled by the various 
institutions and agencies may be offered. Among the children in the boarding 
homes, there was a far greater percentage diagnosed as "normal" than in any 
of the other groups. Thirty-nine of the children in the boarding homes were 
so diagnosed. There were no children diagnosed as feebleminded; four were 
called borderline mental defectives. This may in part be accounted for by 
the fact that among the children in the boarding-homes group were cases in 
which there was no real dependency — in which parents were defraying the 
expense of the support of the child. 

Another difference between the children in the boarding homes and the 
other groups was found in the almost negligible percentage of psychopaths 
coming from the boarding-homes group. There was only one case in the 
boarding-homes group diagnosed as psychopathic personality. 

If environment has any causal relation to psychopathic conditions and our 
social investigation of problem school children would seem to indicate that 
it does, we should expect to find that the dependent child placed in a private 
home would show a smaller percentage of these conditions than the child who 
is placed in an institution where the treatment is not individual, but en masse. 

Twenty-four and two-tenths per cent showed behavior difficulties — dis- 
orders of conduct of such a nature as to have come frequently to the atten- 
tion of the institutional and agency authorities. The smallest percentages came 
from the Children's Home group and the boarding-homes group; the General 
Protestant Orphanage ranked next; and the Bureau of Catholic Charities 
showed the highest percentage. 

As with the public school children, those diagnosed as "normal" were 
on the whole the best behaved, with the percentage of conduct disorders 
increasing, till in the case of psychopathic children it reached 19 out of 26. 
The notable exception was in the group of feebleminded children, where 
only 2 out of 12 were in any way troublesome, both of these giving histories 
of sexual maladjustments. The predominating types of conduct disorder were 
stealing, lying, stubbornness, fighting, sex promiscuity, and sex perversion. 
Most of these are not grave defects in themselves, but their seriousness arises 
from what they may easily become. The greatest care and tact must be exer- 
cised in treating what we are forced to recognize as potentially antisocial 
beings. What is to be avoided is the creating of an antisocial attitude in 
the child, recalcitrant state of mind that becomes more and more difficult 
to eradicate as time goes on. 

Closely related to these behavior difficulties and often causally connected 
therewith are the personality variations and handicaps that may be con- 
sidered as the covert mechanisms which, when put "in drive," issue in overt 
behavior. Fifty-four and six-tenths per cent of the entire group showed one 
or more personality difficulties. The children of the boarding-homes group 
presented the best record, while the Bureau of Catholic Charities and the Gen- 
eral Protestant Orphanage gave the highest percentage of personality handi- 
caps among the children. The "normal" children were also normal as far 
as personality was concerned in practically all cases. 

The types of personality make-up that predominated were the emotional 
and the inadequate, each of which may be due to a variety of causes. It 
is scarcely strange that some children who have been in the care of depen- 
dent and charitable institutions most of their lives should come to feel 
inadequate, if they are at all sensitive. But a mere statistical statement is 
only an indication of the direction in which we should travel, nothing more. 
Careful individual studies alone will reveal the many and varied causes of 



44 MENTAL HYGIENE SURVEY OF CINCINNATI 

these handicapped personalities. Probably nothing is more difficult or more 
important to study than a child's personality make-up and tendencies. 

The median mental age for the group was 8.9 years, and the median 
chronological age was 10.3 years, a difference of a little more than one year. 

Sixty-four and six-tenths per cent of the children showed some physical 
disease or defect or some evidence of physical ill health. The medical problems 
involved here are most important to consider. There were 18 cases of heart 
disease, 30 cases of thyroid disturbance, 46 cases of diseased tonsils, 66 cases 
showing evidence of glandular enlargement, 14 cases of marked malnutrition, 
4 cases of tuberculosis, 1 case of syphilis, 11 cases of anemia, 3 cases of 
spinal curvature, and a great variety of other conditions. Naturally many 
children showed defective teeth, defective vision, defective hearing, under- 
weight, etc. 

It is difficult to understand how the problems of child management and 
placement with which all of these agencies have to deal can be properly 
solved without a knowledge of the mental and physical condition of the 
child himself. A very difficult problem in individual adjustment is represented 
in the case of every child. 

The following case is illustrative of the complex problems presented by 
some of these children: 

Martha's parents had been dead since she was ten years old, when she had become 
a ward of a certain child-caring institution. Since her entry into the institution, Martha 
has been something of a problem, and with the onset of adolesence she has become almost 
unmanageable. There developed rebellious moods and periods of hilarity followed by periods 
of sullen resistance. She ran away on numerous occasions, only to be brought back in tears. 
She was discovered on several occasions in petty thievery. Her school progress was normal. 
At 14 she had entered High School, and seemed to be getting along successfully in that respect. 
At the time of our examination, Martha was 16, and showed normal physical development. She 
was in the second year in High School. Her last escapade was a rather pathetic affair. It had 
been proven that she had stolen money at a previous holiday season, but she persistently 
denied the act and no adequate reason for the theft was discovered until candy began 
arriving for a great many of the smaller girls in the institution, and it was found that 
Martha was the donor. She remained openly defiant and refused to give any further explana- 
tion of her act, although at the time these children had had a sufficient amount of candy 
from other sources. Psychological examination gave no evidence of intellectual defect. 

At the first interview, she denied ever having had any trouble during the time of her 
stay at the institution, and her whole attitude was one of mild surprise that she should 
be questioned. Later on the subject of the stolen money and the candy was very gently 
broached. Martha flushed, became silent, and it seemed that no amount of questioning could 
elicit any kind of reply. She was absolutely negative. However, after further gentle probing, 
the examiner was finally able to draw out the story. It seems that Martha had felt keenly her 
dependency since she had entered the institution. With the approach of adolescence, this 
feeling had greatly increased. In High School she felt that the teachers and other girls left 
her alone because she was an "orphan." At the institution she felt that no one understood 
her, and that they were all "lined up" against her. She had made various futile efforts 
to gain friendship, but had met with rebuff. After each effort towards receiving some' 
intelligent understanding, there would be a reaction of bitter rebellion, during which period 
she became hysterical and frequently ran away. The final bid for popularity had been the 
theft of the money in order to buy presents for the smaller girls. By so doing she had 
hoped to make herself for once a popular member of her social group. Martha's efforts for 
social esteem were the basis of her difficulties. Underneath there was a current of feeling 
that she was a "marked person," different from her fellows and an object of pity. Martha's 
whole appearance indicated the absence of intelligent understanding. She was rather absurdly 
dressed in clothes that she said she knew were "not right" and that made her conspicuous. 
At the time of our examination, the situation had reached the point where Martha was a 
serious problem. She was shut-in, moody, highly irritable, and the authorities were of the 
opinion that she was "going crazy." 

It must not be forgotten that in the case of Martha there was probably fertile soil for 
development of mental disorder before she went to the institution. However, the situation 
had been greatly aggrevated by a repressive, routine atmosphere. It was not that Martha 
had ever been treated unkindly. Those in charge of her felt, and rightly so, that they 
had been very patient with a girl who was very "hard to manage." She had received more 
privileges than most of the other girls, but there had been no intelligent understanding 
of her make-up and the mental conflicts that were the essential causative factors in her 
behavior. Martha is now a distinctly psychopathic type and there is a possibility that an 
even more serious mental disorder will develop. Her behavior problems find their origin 
in her mental conflicts. There is not much doubt that if she had been in skilled hands at 
an earlier period in her career, much may have been done to prevent the condition which 
she now presents. As it is, a great deal yet can be accomplished through intelligent handling 
based upon an understanding of her mental conflicts and mental make-up. 



MENTAL HYGIENE SURVEY OF CINCINNATI 45 

ADULT DEPENDENCY 

Adult dependency presents a different picture from that of juvenile depen- 
dency. In the one — juvenile dependency — careful study and training, as well 
as treatment of each child, are the essential needs. In the other — adult depen- 
dency — we are dealing with the end results of our failure to recognize im- 
portant conditions early and to set in motion the proper machinery to pre- 
vent more serious after effects. 

In adult dependency we see, on the one hand, a failure on the part of 
orphanages and social organizations to recognize early in childhood conditions 
within the individual himself that lead later on to social failure — this because 
these agencies now have no satisfactory place to send their cases for diagnosis 
and treatment. We see here a lack in the public schools system, of facilities 
for dealing with children showing serious behavior difficulties, particularly 
those suffering from nervousness, endocrine disorders, epilepsy and marked 
psychopathic conditions, all of which make for dependency later on in life if 
children so handicapped are not properly trained. Some few, probably very 
few, belong to that unfortunate class that never could have taken care of 
themselves in life — the very low-grade feebleminded; while a large number — 
those suffering from mental disease who are now in need of hospital care 
rather than financial relief of their dependency — might have been saved from 
mental shipwreck had they early received proper psychiatric diagnosis and 
treatment. 

BUREAU OF CATHOLIC CHARITIES 

Sixty-one adult cases were studied at this bureau, of whom 30 were men 
and 31 women. Forty-one were native born (18 of native parents), while 
the 20 foreign born came from 6 different countries. 

The physical condition of only 9 of them was considered good; 36 were 
fair and 16 were poor. These figures are significant, and yet they do not 
tell all the facts of physical disease and ill health that we found in our 
examinations. Years of poverty can scarcely be called a builder of robust 
constitutions, and it is to be expected that these people will be in good health 
only in rare instances. The entire 61 are at present partially dependent, 20 
of them having been so from two to ten years. This dependency means, not 
that they are receiving training, but that they are being given charitable aid 
and perhaps help in the finding of jobs. The 41 who became dependent within 
the last year will in all likelihood remain so unless some chance lifts them 
out of this condition, or unless something more intelligent and fundamental 
is done for them than merely giving them financial relief and securing them 
a temporary job. 

Thirty-six of the group had been married, but 20 of the 36 were either 
widowed, divorced, or separated. 

Careful mental examinations of these individuals brought out the facts that 
15 were normal, 8 subnormal, 6 cases of borderline mental defect, 4 feeble- 
minded, 7 psychopathic, 5 psychoneurotic, 1 epileptic, 1 suffering from en- 
docrine disorder, and 13 suffering from mental disease. Such a picture shows 
how futile it is to attempt the adjustment of dependent individuals without 
an intimate knowledge of the individuals themselves. Many of these people 
could have been saved from mental deterioration and serious social failure 
had they received early in life the proper training and treatment suited to their 
condition. As it is, a great many of them are now in need of either perma- 
nent custodial care or hospital treatment. 

Even such a study as the above tells only part of the story. The in- 
dividual's personality acts as the driving force in all his reactions. Forty-six 
of this group showed personality difficulties, with emotional and inadequate 
personalities predominating. These difficulties are both cause and effect of 
the situations in which these suffering from them are imbued, but once 
started, they are not to be removed by removing merely the external stimulus. 
*" we have reiterated, the mere statement of types of personality make-up 



46 MENTAL HYGIENE SURVEY OF CINCINNATI 

gives no real understanding of the individual. Each individual is a case unto 
himself and must be dealt with as such. 

These personality handicaps and character defects are often let alone, 
though they may be ruining a person's whole life, till they issue in overt 
expressions of antisocial behavior. That is what happened in 10 of the 
above cases, sex offenses and drunkenness predominating. The mere state- 
ment of the frequency of these personality handicaps does not indicate that 
all of the individuals rated as possessing them are troublesome. It only 
indicates the vicinity of trouble. As was to be expected, the cases of behavior 
and personality difficulties are drawn entirely from the ranks of the mentally 
abnormal, with few coming from the dull and subnormal — the percentages 
increasing till we find them much larger among the feebleminded, psycho- 
pathic, and mentally diseased. 

Given the above conditions, it is scarcely to be expected even in normal 
times that many of this group will find steady employment. Fifty-nine of 
them were unskilled in any occupation, only 2 being skilled workers. Only 
10 gave a history of having had regular employment, 7 had had no work at 
all, while 9 had existed doing odd jobs. Only 2 out of the 9 in good health, 
and 6 of the 36 in fair health were regularly employed. Surely society has 
little reason to be proud of these 61 people, or of what it has done for them. 

FIFTY DEPENDENT JEWISH FAMILIES 

(Dr. Rose Dintzess) » 

The purpose of this study was to determine the mental condition of de- 
pendent families coming in contact with the United Jewish Social Agencies. 
For this study, 50 families taken at random from about 400 families on the 
current relief records of the United Jewish Social Agencies were subjected to a 
thorough physical, psychological and psychiatric examination, and the results 
thus found were correlated with the condition of dependency shown on the 
records of this agency. 

The 50 families chosen comprised 212 individuals ranging in age from 
6 to 68 years. 

TABLE 25— AGES 

Age Males Females Total 



6 — 10 years 


43 


20 


63 


11—15 


» 


27 


21 


48 


16—20 


» 


8 


8 


16 


21—25 


J> 


, . 


1 


1 


26—30 


" 


1 


2 


3 


31—35 


» 


6 


8 


14 


36—40 


" 


7 


14 


21 


41—45 


J> 


10 


12 


22 


46—50 


>t 


7 


4 


11 


51—55 


" 


4 


5 


9 


Over 55 


years 


4 




4 



Total, 117 95 212 

One hundred and eighty-one showed physical defects or disease of some 
kind. 

Psychological tests showed an average mental age of less than 11 years. 

The psychiatric and psychological examinations disclosed only 82 persons 
with no marked personality difficulties. 

The mental diagnosis is shown in the following table. 



MENTAL HYGIENE SURVEY OF CINCINNATI 



47 



TABLE 26— MENTAL DIAGNOSIS 

Diagnosis Total Adults Children 

Males Females Males Females 

Normal 61 6 2 34 19 

Dull normal 45 5 9 19 12 

Subnormal 17 5 7 2 3 

Borderline mental defect.... 14 6 4 2 2' 

Mental defect 18 6 6 2 4 

Pre-psychopathic 13 . . . . 12 1 

Psychopathic 17 7 6 2 2 

Psychoneurotic 19 2 11 1 5 

Endocrine 4 .. 1 2 1 

Mental disease 4 2 .. 2 

TOTAL 212 ~~39 46 ~~ 78 ~~ 49 

Twenty-five individuals were found to be totally illiterate, and 30 had 
never entered any kind of school. 

Behavior difficulties were shown in 28 cases. 

The majority had had institutional care. 

More than half of the individuals (130) were American born, 36 were 
naturalized citizens and 46 were aliens. 

Five individuals had been arrested. 

Most of the persons studied came from an urban environment. The rural 
types were all deficient. 

The extent of dependency for the different groups encountered is shown 
in the following table: 

TABLE 27— EXTENT OF DEPENDENCY 

Total Con- Inter- Occa- 

tinuous mittent sional 

Normal 7 2 2 3 

Dull normal 7 2 2 3 

Subnormal 7 1 3 3 

Borderline mental defect. . . 6 4 11 

Mental defect 8 3 3 2 

Psychopathic 8 1 4 3 

Psychoneurotic 4 4 

Mental disease 3 111 

TOTAL 50 18 "~16 ~~ 16 

A large proportion of widowhood, as shown in the next table, may aid 
in explaining part of the dependency: 

TABLE 28— MARITAL CONDITIONS 

Single 126 

Married 72 

Widowed 10 

Divorced 4 

TOTAL ~212 



MENTAL HYGIENE SURVEY OF CINCINNATI 



Most of the husbands were considerably older than their wives, as shown 
in the following table: 

TABLE 29— RELATIVE AGES OF HUSBANDS AND WIVES 

Husband Wife 
Older Older 

Number of cases 29 6 

Difference less than five years 7 6 

Difference from 5 to 10 years 14 

Difference from 10 to 20 years 6 

Difference over 20 years 2 

Average difference 8 years 3 years 

The age distribution shows an absence of young adults, which emphasizes 
the fact that dependency is often related to industrial inefficiency, and that 
young adults are only exceptionally in need of charitable assistance, as was 
demonstrated by Hornell Hart, in his study of poverty in the city of Milwaukee 
in 1915. 

The family groups were quite diverse, varying from a widower and ah 
only son to a family of two parents and six children, within the ages studied. 
The large proportion of widows here is certainly one of the potent factors in 
causing dependency in a number of cases. 

The difference between the ages of husband and wife was especially 
striking. This may be an important contributing factor in dependency, since 
it) implies that the husband may become superannuated while the wife is still 
maintaining a youthful household. In three-fifths of the cases the husband 
was over five years older than the wife; in one case as much as 26 years 
intervened. A study by Miss Edith Hoffheimer, in 1919, indicates that this 
condition is only an exaggeration of a tendency constantly present among 
the Jewish people of Cincinnati, which may be due in part to general Jewish 
custom and in part to the economic pressure and unsocial life of many of the 
young emigrants here, which causes them to postpone marriage until they 
become acclimatized or save enough to be able to send back to Europe for 
a bride. 

Physical deficiencies are probably an important factor in the causation of 
dependency. In every case of family dependency where the head of the family 
is normal or dull normal, sickness was the only reason given for their applica- 
tion for assistance. Nine per cent of the individuals examined were definitely 
tuberculous, and about the same number showed signs of a predisposition 
thereto while another nine per cent showed definite heart lesions or rheuma- 
tism. Many complained of gastric disturbances, especially of chronic constipa- 
tion, and another large group reported bronchitis and inflammations of the 
upper respiratory passages. 

Underweight, bad teeth and defective vision were the most frequent 
defects disclosed, and are probably of importance in lessening the resistance 
to more acute disorders. Twenty-three cases of endocrine disturbance, five 
cases of hernia, five instances of enuresis in children, and only three cases 
of syphilis were among the unexpected conditions revealed. 

The parents generally showed a much lower intelligence quotient than 
their children, the mothers especially appearing deficient in this respect. In 
the individual tests these individuals showed rather more concrete and mathe- 
matical ability, and an inability to handle abstract ideas, and a lack of general 
information and of memory. Illiteracy was astoundingly prevalent, and con- 
fined exclusively to the older generation. Twenty-five persons were abso- 
lutely illiterate, and of the remainder very few could read or write in the 
English language. Most of these were Russian Jews and had been unable to 
obtain a public education. They could at best attend only the private Jewish 
schools (Cheder) where the teaching consists mainly of memorizing prayers, 
and only the more capable children can learn to read and write. Most of them 
are artisans or small tradesmen with no need for literacy in their occupations. 
Some of them started to night schools in English classes, but for lack of incen- 



MENTAL HYGIENE SURVEY OF CINCINNATI 49 

tive and facilities, they soon dropped out. They do not become Americanized, 
they live among people who speak the same tongue, and find no necessity for 
changing their customs, and, therefore, continue in the same life that they had 
led in their own little village in their own country. 

The extremely low intelligence quotients of the mothers, averaging only 
55, and the intelligence quotients of the fathers, averaging 64, are extremely 
enlightening when compared with the intelligence quotients of their children, 
averaging 90. This indicates one of the great difficulties in the way of Ameri- 
canization work among adults and the greater promise of such work among 
the children, and reveals an important factor in the uncongenial atmosphere 
in the homes of many of these emigrant families and the estrangement of the 
children from their parents, with the loosening of the home ties, and of the 
bonds of filial respect and obedience. 

The language difficulty was met in many cases, but whenever it was felt 
that the knowledge of English was insufficient to give a true estimate of the 
mental age of the subjects, performance tests were used instead of the regular 
Binet-Simon tests. 

Closer study of the children revealed the curious facts that the younger 
children almost uniformly showed a higher intelligence quotient than their 
elder sisters and brothers, as well as a superior mental diagnosis, while in the 
physical examination the elder children appeared to better advantage. The 
regularity of this phenomenon is in accord with the theory of inheritance of 
acquired characteristics, as interpreted by Caspar Redfield, and applied in this 
connection by Dr. Martin H. Fischer. Thus the children of younger parents — 
that is to say, the older children in our table — showed a much lower intelli- 
gence quotient and a poorer mental diagnosis than the younger children, 
whose parents must have been correspondingly older at the time of their birth. 
And not only is this true in extremes, but it appears to be the general rule 
among intervening children as well. 

Most of the parents were foreign born, but only 10 had been in America 
less than ten years, and most of the others had been in this country over 15 
years. Yet only 36 of the foreign-born adults had become naturalized during 
that time, and the general low level of mentality, in spite of such a long stay in 
this country, indicates a lack of capacity for advancement in this group. It is 
interesting to note that every one who admitted a rural environment in Europe 
was definitely below normal — showing the effect of lack of progress — from 
the standards of their previous environment. 

The great preponderance of emotionally unstable individuals among par- 
ents and children discloses a fundamental psychological background — possi- 
bly racial in origin — which may aid in interpreting the prominence of the psy- 
choneurotic and psychopathic types found in this study. The egocentric make- 
up was genrally associated with psychopathic individuals while the inadequate 
types were generally adults of very inferior mentality. 

The psychiatric examination showed that in only two families was every 
member normal. It is interesting to note that the cause of dependency in these 
cases was, the death of a husband in the one, and the death of both parents 
in the other. As may be readily understood, most of the normal and dull 
normal individuals were children, and as a converse, most of the children 
were normal in type. 

Normal and dull normal individuals are able to meet the exigencies of 
ordinary life, and become dependent generally only in case of sickness or 
accident. They generally left Europe to escape pogroms, or military service, 
or to join relatives in this country. 

Subnormal individuals are mostly illiterate and of a low industrial 
standard. They lack ambition and easily become pauperized, but are apt 
to attribute their poverty to external causes. Many of them were unable 
to make a living in the old country, and came to America hoping for better 
luck. 

Cases of borderline mental defect and feebleminded individuals rarely 
have any education and in general are chronically dependent. They are sel- 
dom skilled, but the adults do odd jobs or peddle. It is especially important to 



50 MENTAL HYGIENE SURVEY OF CINCINNATI 

rote that although 22 adults were found to belong to this group, only 10 chil- 
dren were so diagnosed. In all but one case, where one or both parents were 
so diagnosed, some of their children, especially the younger ones, appeared to 
be practically normal and in some cases even superior in intelligence and 
ability. 

The psychoneurotic women generally presented a condition that we have 
called hyperactivity. A few psychopathic women also showed this condition. 
These women are generally of a higher degree of intelligence, initiative and 
energy than their husbands but lack an outlet for expressing their individual- 
ity and represent somewhat of a reversion to the matriarchal, relics of which 
are still to be encountered in Jewish life. They are generally poor house- 
keepers, autocratic and tyrannical at home, repressing their children's indi- 
viduality, very difficult to get along with, incompatible with their neighbors, 
and a constant source of friction with the social agencies dealing with their 
families. 

The psychoneurotic men were generally individuals with a pronounced 
hypochrondriac tendency — so often met with in Jewish communities — who 
had become afflicted with some somatic disease, resulting in general physical 
weakness. 

The psychopathic group were generally men of fair physical and industrial 
ability who lacked ambition, initiative, and a strong sense of duty. They were, 
in general, of two sorts. The first, or inadequate type lacks self-respect, and 
is, therefore, easi]y pauperized. They are lazy and often neurasthenic, but 
often show considerable family feeling. The second or egocentric type, 
are shallow, selfish, and essentially lacking in family feeling. They are prone 
to desertion and sex promiscuity, are unstable in work, hard to manage, change 
jobs very often, and are continually having difficulties both with their 
employers and with their fellow workingmen. 

One or more of the children of practically every psychopathic parent 
studied, showed some psychopathic traits from early in life, both at home and 
in institutions where they happened to be examined, and were consequently 
diagnosed as pre-psychopathic. These children do not get along well in school, 
are disobedient at home and give considerable trouble in institutions by 
fighting, petit larceny, and untruthfulness. 

Behavior difficulties were infrequent in this group, suggesting that, for 
the most part, dependency here is not an outgrowth of delinquency. It may 
be mentioned in^ this connection that only five of these individuals had ever 
been arrested, and these mostly for trivial offences. Family desertion and 
fighting, usually found in psychopathic men and women, stealing and truancy, 
or running away, found among their pre-psychopathic children, constitute the 
main difficulties reported. In other words, as is usually the case, the psy- 
chopathic group furnish practically all of the delinquency noted in this study. 

An enormous amount of institutional care was reported. Practically every 
individual had received medical treatment at the Beckman Dispensary; more 
than half had been at the Convalescent Home; a third had been at the Jewish 
Hospital; and 45 children had for some time been at the Jewish Foster Home. 
It must be remembered, however, that the United Jewish Social Agencies util- 
izes the Convalescent Home as a summer-vacation camp for underweight chil- 
dren, that children are sent there when their parents are in the hospital, and 
that almost all patients are sent there from the hospital during the period 
of convalescence. Neverthless, the figures demonstrate the great significance 
of disease as an etiological factor in dependency in this group. 

The data on duration and extent of dependency were taken from the 
records of the Jewish Relief Agency and checked over by the superintend- 
ent of the United Jewish Social Agencies. About equal numbers of families 
are found to be totally dependent, partially or intermittently dependent, and 
receiving only occasional relief. When these figures are compared with the 
mental diagnosis of the parents, the relationship between mental make-up and 
economic status is revealed. The normal and dull normal families received 
only occasional relief — necessitated by the sickness or death of the bread- 



MENTAL HYGIENE SURVEY OF CINCINNATI 51 

winner. The subnormal, borderline mental defectives and feebleminded on 
the other hand, tend to be dependent for long periods of time. These con- 
stitute the most important problems, since they are likely to become a perma- 
nent charge upon the community. The normal families are very "touchy" about 
their dependency, which was in every case, due to some external cause. 
The dull-normal families were less sensitive on this point, but were in the 
main, partially self-supporting. The feebleminded group, however, took 
charity as a matter of course. Most of the adults come over with some slight 
skill in a trade and continue in it — as tailor, shoemaker, etc. — unless they fail, 
in which case they are apt to take up peddling. Many of the boys sell news- 
papers. Very few of the women work, as the United Jewish Social Agencies 
insist that they keep house and take care of their children, a policy that is 
strikingly at variance with that observed by other social agencies, where the 
woman is encouraged to go out working or to take in washing. In this 
connection, attention may be called to the condition of the hyperactive women 
referred to above, who appear to be suffering from this rule. 

As a result of the information obtained in this study of 50 families, definite 
suggestions and recommendations for the further treatment and care of this 
group, were given in the case of over 80 individuals, involving 36 families. It 
is believed that many of these will have a pronounced effect in solving some of 
the problems in these cases. In addition, it is suggested that every new 
family applying for relief be given a thorough physical, psychological, and 
psychiatric examination, as well as a social investigation, and that the follow- 
ing general suggestions be considered: 

1. Normal individuals are dependent usually only as a result of disease, 
and when this is relieved, repeated applications for further assistance should 
be discouraged. 

2. Mentally deficient families must be considered as more or less chronic 
charges upon the community. It is not generally advisable to expend much 
money in establishing these in business, but they may often be taught some 
simple trade, or established in peddling, etc., by which they may become 
wholly or partially self-supporting. The children in these families are the 
main reliance for the solution of their problems. They should be watched very 
carefully to protect them from bad home conditions, and to note the develop- 
ment of defects, and it may often be advisable to give them vocational training 
to hasten or increase their earning power later on. Specialized industrial 
training for all defective children is essential if they are ever to be handled 
safely out in the community. 

3. Psychoneurotic individuals of the hyperactive type may well be encour- 
aged to go to work. The neurasthenic type should receive medical treatment 
and be steadily encouraged in their efforts. The children should be watched 
and their environment adjusted to overcome emotional instability. 

4. Psychopathic individuals require the most tactful and understanding 
approach and treatment. They should be made to realize their responsibilities, 
even to the extent of invoking the assistance of the court, and their applications 
for relief should not be encouraged. Their children must be watched carefully 
for the development of psychopathic traits. 

5. Friendly visitors should observe the children with emotional tenden- 
cies. The physical basis for these conditions should be corrected, bad home 
conditions improved, and outdoor life encouraged. Visiting teachers, visiting 
housekeepers, or nurses, may do well to instruct the mothers regarding 
diet — especially as to the use of vegetables and fruits — to prevent the prevalent 
constipation reported. 

6. When new children are to be sent to the Convalescent Home or the 
Foster Home, care should be taken to notify the matron of psychoneurotic 
or psychopathic traits, of the presence of feeblemindedness, epilepsy, and 
such conditions, in order that appropriate measures may be taken for dealing 
adequately with these children. An attempt should be made to create, as far 
as possible, a home atmosphere in these institutions; and an effort should be 



52 MENTAL HYGIENE SURVEY OF CINCINNATI 

made to individualize in the treatment of each child. 

7. Children in such institutions should be observed carefully. Such an 
environment offers a particularly good opportunity for a comprehensive study 
over a prolonged period, which will make proper diagnosis and suitable treat- 
ment possible. 

ASSOCIATED CHARITIES 

122 RELIEF CASES 

Of the 122 relief cases studied at the Associated Charities, 120 were native 
born, 98 of them of native parents. 

Thirty-six were in such poor physical condition as to be in need of urgent 
medical attention. The great majority of this group — 72 out of the 122 — have 
become dependent within the year, while approximately 20 per cent have 
been dependent from 2 to 9 years. It is notable that the smallest percentage 
of dependents of over one year is to be found among the normal individuals, 
while the percentage increases till it includes the majority of the feebleminded 
and mentally diseased persons and almost half of the cases of borderline 
mental defect and psychopathic personality. This is another indication « of 
what early diagnosis, medical treatment, and the right sort of educational train- 
ing might have done. A great many of those diagnosed as mentally abnormal 
could have been made into happy useful citizens. 

The percentage of married persons among these 122 relief cases is much 
larger than the group at the Bureau of Catholic Charities. Here 104 were, 
or had been married — of whom 21 were widowed and 16 unable to live to- 
gether. Only 18 of the entire group remained single. Thirteen of the 15 cases 
of borderline mental defect were married, seven of the 11 feebleminded per- 
sons, 2 of the 3 epileptics, 8 of the 11 psychopaths and 20 of the 23 cases of 
mental disease. 

The median mental age of this group was 11 years. (They were all adults.) 

The table on mental diagnosis shows that of the 3£. whites, 26 were 
"normal," 5 were subnormal, 10 were cases of borderline ni&ijtal defect, 9 were 
feebleminded, 9 cases of psychopthic personality, 7 cases of psychoneurosis, 
3 cases of epilepsy, 2 individuals suffering from endocrine disorders, and 21 
cases of mental disease. The mental diagnosis of the negroes ran as follows: 
"normal" 8, subnormal 9, borderline mental defect 5, feebleminded 2, psycho- 
pathic personality 2, endocrine disorder 2, and mental disease 2. 

This table of diagnosis is a striking commentary on our methods of deal- 
ing with dependency by old-time methods of relief. Here we have in a large 
proportion of cases individuals who are mentally sick or mentally handicapped 
and in a great many cases physically ill, individuals who are in need of hospital 
care or institutional care. Much of this condition is in a way preventable if 
we give to these persons, early in the game, proper diagnosis and suitable 
training and treatment. 

Fourteen of these individuals never attended school, but we are not sure 
that as regards dependency they fared worse than the 98 who did attend 
school, but received no individual training along industrial and vocational 
lines to fit them for a job and to earn a living in life; 38 did not go beyond the 
fourth grade; 55 left school between the fifth and eight grades. Such problems 
as the mentally handicapped child presents have in a large measure been 
considered by preparatory schools and university authorities as unimportant, 
the usual process being to let them hang on as long as they are able to keep up 
to a certain intellectual and behavior standard, but to drop them as soon as 
they become really troublesome. While this is true in many parts of this 
country, it cannot be said of Cincinnati. The public school system of this 
city is making unusual strides in the direction of meeting the problems of the 
special-class child. 

Seventy-eight of the 122 individuals showed very marked personality diffi- 
culties and character defect. Much might have been done for these cases — 
much can still be done for many of them — but the present policy of social 



MENTAL HYGIENE SURVEY OF CINCINNATI 53 

workers, which consists of writing them up in their case histories as "queer 
sorts" and doling out funds for their temporary relief — funds that are in the 
long run thrown away — leads us nowhere towards solving their problems. 
Nor does it get us anywhere in clearing up the situation if, when the person- 
ality difficulties of these individuals issue in overt behavior, we straightway 
send them to jail. 

In 25 of these 78 cases, personality difficulties did actually issue in overt 
behavior, of which sex promiscuity (6), drunkenness (3) and fighting (5) pre- 
dominated. Those classed as "normal" showed no personality difficulties, and 
did not exhibit anti-social behavior, while the psychopaths almost invariably 
got into trouble. Of the 25 offenders, 22 misbehaved seriously enough to be 
arrested, six out of the 22 were repeated offenders. Only 13 of the 122 cases 
had ever been regularly employed, 31 had had no work, and 78 had done odd 
jobs, or had done house work at home. None of the individuals classed as 
feebleminded, borderline mental defectives, psychopathic personalities, epilep- 
tics, or cases of mental disease, had been regularly employed. 

The physical condition is a very important factor, only one out of the 
36 found to be in poor health had been regularly employed. 

ASSOCIATED CHARITIES 

100 UNEMPLOYMENT CASES 

Of this group of 100, 92 were men and eight were women; 83 were white 
and 17 were colored; 94 were native-born, 68 of native-born parents. 

These were in no sense chronic dependents, 42 being still non-dependent; 
while 51 of the remaining 58 had become dependent within the last year. 
The smallest percentage of dependence came from the normal group; five of the 
seven feebleminded were dependent, as were eight of the 18 psychopaths, 
two of the three epileptics and 10 of the 12 suffering from mental disease. This 
is to be expected, for given chronic unemployment, the normal individuals will 
always be the last to lose their jobs, and the last to succumb to charitable aid. 

Thirty-eight of the group were married. 

The median mental age for the group was 12 years; 37 had a mental age of 
10 years or under. The table of mental diagnosis shows that 28 were 
"normal," 17 subnormal, 11 were cases of borderline mental defect, seven 
were feebleminded, 18 were cases of psychopathic personality, two were psy- 
choneurotics, three were epileptics, 12 were cases of mental disease, one indi- 
vidual had an endocrine disorder and one was undiagnosed. 

Twenty-five failed to get beyond the fourth grade in the public schools 
(only five of these individuals were "normal"). Fifty-two dropped out between 
the fifth and eighth grades, 17 went to High School, six never went to school. 
Our public schools, in a measure, failed to equip these individuals for life. 
When a man's business is running poorly, he does not scrap it, thus wasting all 
he has already put into it. He studies the situation carefully, and as often as 
not saves it by increasing his investment. 

Sixty-three of these individuals were handicapped by personality difficul- 
ties and character defects. Twenty-four of the 100 cases gave a history 
of behavior difficulties and conduct disorders, in which fighting and drinking 
predominated. A record of having come into conflict with the law, of being 
arrested, was obtained in the case of 36 individuals, 15 of whom were repeated 
offenders. 

Ninety of these cases of unemployment were unskilled workers. Is it per- 
tinent to ask here what our educational system did for the 69 individuals that 
passed through the fifth grade and went beyond? 

THE CITY INFIRMARY 

This institution is located at Hartwell, Ohio, about 40 minutes from Cin- 
cinnati by street car. The institution is located on a farm of 167 acres, of 



54 MENTAL HYGIENE SURVEY OF CINCINNATI 

which only about 60 acres are tillable, the rest being grazing land. The soil 
is poor. 

BUILDINGS 

The main buildings are very old, and were erected originally for use as a 
convent. The construction of these buildings is of massive stone and masonry 
throughout. They are poorly adapated for the use to which they are being put. 
The floors are very bad, and the plumbing is totally inadequate. There have 
been no repairs worth mentioning made on the buildings since they were 
used as a convent more than 50 years ago. 

The institution has a capacity of 800 or 900 inmates. Only between 400 
and 500, however, are at present in it. It exists, as a custodial institution, 
for old men and women — residents of Cincinnati. Applications for admissions 
are made to the Department of Public Welfare of the City of Cincinnati. From 
January, 1920 to December 31, 1920, there were 114 admissions — 87 men and 
27 women. 

There are 11 buildings in all. The principal buildings, however, are the 
hospital, the building for negroes, main building and the chapel. The latter is 
idle six days a week. There are four wards for men and three for women, two 
hospital wards for men and three hospital wards for women. The wards are 
made up of separate rooms, averaging 3 inmates in a room. The rooms are 
very small and poorly ventilated and there is no plumbing in any of them. 

The men are segregated from the women and the blacks and whites are 
separated. There is a large number of insane persons but there is only a rough 
segregation of these cases. The untidy cases are kept in separate rooms — two 
and three in a room. 

FOOD 

The food is very poor. Breakfast consists of coffee, bread and molasses. 
Dinner consists of soup or tea, boiled beef, potatoes and another vegetable and 
bread. Supper consists of tea, bread and molasses. The food that is given the 
attendants is of not much better quality. The hospital has milk, butter and 
eggs every day. 

MEDICAL ATTENTION 

The only medical attention is furnished by the Cincinnati General Hospital. 
Regular visits are made by physicians from the Hospital who see cases that 
have requested medical attention. There is no routine medical inspection, either 
at time of admittance or during stay in institution. The institution, housing as 
it does, old people suffering from many types of chronic diseases, has inade- 
quate medical service. 

SUMMARY 

In its present state of repair, this institution is a very poor one. The 
inmates are on the whole, kindly treated, but the equipment is so wretchedly 
inadequate, and the food so poor that the atmosphere in the place is very 
depressing. The institution at the time of inspection was only about half 
full, but without further repairs, it is difficult to see how it can be made a 
usable institution for housing dependents. 

HAMILTON COUNTY HOME 

This institution is located at Carthage, Ohio, and serves as a home for 
dependent old people of Hamilton county. There are six buildings in all, but 
most of the inmates are housed in the main building, which is a three-story 
brick structure. The building is in a good state of repair and is adequate for 
the purpose. It is located on a farm of 100 acres of sandy soil with good 
drainage. At the time of inspection, there were 166 inmates — 48 men and 118 
women. There had been admitted during the year from February, 1920, to 
February, 1921, 56 individuals — 44 men and 12 women. 



MENTAL HYGIENE SURVEY OF CINCINNATI 55 

FOOD 

The food is very good. Breakfast consists of rolled oats, coffee with milk, 
bread and molasses. Dinner consists of vegetable soup, potatoes and beef, 
sliced tomatoes or other vegetables. Supper consists of prunes, bread, butter 
and tea. The hospital has milk, butter, and eggs twice a day. There is a 
house doctor who is paid by the institution for his services. There are two 
hospital rooms for males and one large ward. The women are cared for in 
their rooms when sick. The hospital equipment is fair. Serious cases are sent 
to the City Hospital. 

SUMMARY 

This institution is clean and well kept. It does not have the earmarks of 
the usual county home. Inmates seem well cared for and fond of the superin- 
tendent and matron, who treat them most humanely. There are no routine 
physical examinations, blood tests, or medical records. There is no effort 
made at evaluating the mental status of the inmates. There are a number 
of insane housed in the home. 

There were 162 persons studied at the Hamilton County Home and 394 
at the City Infirmary. 

The problems presented by the City Infirmary and the Hamilton County 
Home are somewhat different from those of the other organizations. They 
represent the lowest end of the scale, the chronic dependents — the mentally 
and physically diseased and defective and the very aged. The range of ages 
in the City Infirmary was from 26 to 110, with only 10 under 40 and the vast 
majority between 55 and 85. In the Hamilton County Home, the median age 
was 70 to 74, the vast majority lying between the ages of 60 and 80. Only 
six in the Hamilton County Home and 19 in the City Infirmary were in good 
physical condition; in the former 69 were in such poor or bad physical condi- 
tion as to be in need of urgent medical treatment, while in the latter 222 were 
in a similar physical condition. 

The percentage of native-born was smaller in these two groups than in 
any of the preceding, 93 out of 162 in the Hamilton County Home being native 
born and 50 of native-born parents, while 246 out of 394 in the City Infirmary 
were native born, but only 66 of native parentage. 

All the members of both groups are at present wholly dependent, 27 of 
the Hamilton County Home and 51 of the City Infirmary having become so 
within the year. In the former institution, 48 have been dependent from two 
to five years, 39 from six to nine years, 38 from 10 to 20 years, and 10 over 20 
years; in the latter the situation is as bad, 101 having been dependent from two 
to five years, 101 from six to nine years, 88 from ten to twenty years, and 29 
twenty years and over. (Record not obtained on remaining cases). 

Sixty-eight of the 162 in the Hamilton County Home had been married 
(15 of whom had separated or were divorced), and 207 of the 395 in the City 
Infirmary had been married (27 of whom were separated or divorced.) The 
number widowed in both institutions is extremely high — 47 in the Hamilton 
County Home and 151 in the City Infirmary. 

As regards the schooling of these individuals, in the Hamilton County 
Home, 16 had never been to school at all. All of these individuals showed 
some mental abnormality. Fifty-five had dropped out by the end of the fourth 
grade and 41 more by the eighth grade; five had been to high school and four 
to college. In the City Infirmary group, 40 had had no schooling at all (five 
of whom were normal) 123 left before the fifth grade, 102 between the fifth 
and eighth grade, eight had gone to high school and four to college. 

Thirty-five of the inmates of the Hamilton County Home, and 126 of those 
at the City Infirmary gave a history of past behavior difficulties, such as fight- 
ing, sex promiscuity, alcoholism, etc. Thirty-four of the former group had 
been arrested (16 were repeaters), while 112 of the latter had been arrested 
(63 of these were repeaters.) 

In the Hamilton County Home, there were 17 skilled workers, and 129 
unskilled. Six had never done any work at all. In the City Infirmary there 



56 MENTAL HYGIENE SURVEY OF CINCINNATI • 

were 32 skilled workers, 326 unskilled, and one had never worked. The 
remainder were unable to give their industrial history. 

The mental diagnosis of the group at the Hamilton County Home showed 
that of the 154 white, only four and five-tenths per cent were diagnosed as 
"normal," five and two-tenths per cent as subnormal, five and two-tenths per 
cent as borderline mental defectives, nine and one-tenth per cent as feeble- 
minded, two and six-tenths per cent as psychopathic personalities, six-tenths 
per cent as psychoneurotics, one and nine-tenths per cent as epileptics, 58.4 
per cent as cases of mental disease, 10.4 per cent as case of senility without 
deterioration, and one and nine-tenths per cent were undiagnosed; of the eight 
negro inmates, two were classified as feebleminded and six were suffering from 
mental disease. 

The mental diagnoses of the group at the Hamilton County Home showed 
that 20.3 per cent were classified as "normal," eight and five-tenths per cent 
as subnormal, four and five-tenths per cent as borderline mental defectives, 
11 per cent as feebleminded, five and one-tenth per cent as cases of psycho- 
pathic personality, eight-tenths per cent as psychoneurotic, 45.1 per cent as 
suffering from mental disease, three-tenths per cent from endocrine disorders, 
and four and five-tenths were undiagnosed; of the 39 negroes, three were 
"normal," two subnormal, three borderline mental defectives, six feebleminded, 
one psychopathic personality and twenty-four suffering from mental disease. 

From 60 to 70 per cent of the inmates of these two institutions were 
suffering from either mental disease, epilesy, or feeblemindedness. If this 
data shows anything it is that the most outstanding problems presented by 
these persons is one of mental disorder — a medical problem. These persons 
are primarily sick persons, needing medical treatment as well as good food, 
comfortable surroundings, and kindly care. 

The tendency more and more today is to convert our almshouses, county, 
and city homes into real hospitals, equipped as such and manned by proper 
medical personnel. 

SUMMARY OF DEPENDENCY STUDY 
JUVENILE DEPENDENCY 

Of 359 children studied in connection with the Children's Home, the 
General Protestant Orphanage, the Bureau of Catholic Charities, and the 
boarding homes, the vast majority were native born; only two negro children 
were examined. The children ranged in age from five to 18 years. The 
median chronological age was 10.3 years. 

Thirty-two and three-tenths per cent were retarded in school from two 
to eight years. Seventy-seven and four-tenths per cent were considered close 
enough to the city norm to be classed as average in intelligence. 

Sixty-eight and eight-tenths per cent were classified as "normal." This is 
quite in contrast to our group of delinquent children, in which approximately 
two-thirds were classified as suffering from subnormal intelligence, mental 
defect, psychopathic personality, epilepsy, etc. 

Approximately 24 per cent of these children showed delinquent tenden- 
cies, in that they exhibited conduct disorders, such as, lying, stealing, fighting, 
bad sex practices, etc. 

Sixty-four and six-tenths per cent of these dependent children showed 
some physical disease or defect or evidence of physical ill health. 

ADULT DEPENDENCY 

Adult dependency presents quite a different picture in that the majority 
of the individuals studied were mentally or physically sick and handicapped 
persons. 

BUREAU OF CATHOLIC CHARITIES 

Of 61 cases studied, 30 were men and 31 were women, 41 were native-born 
(18 of native-born parents) while the 20 foreign born came from nine different 



MENTAL HYGIENE SURVEY OF CINCINNATI 57 

countries. The physical condition of 16 was such as to call urgently for 
medical attention. Thirty-six were married, but 20 of these were widowed, 
divorced, or separated. 

Seventy-five per cent of these persons were either subnormal in intelli- 
gence, mentally defective, or suffering from epilepsy, psychopathic personality 
or mental disease. 

Fifty-nine persons were unskilled workers; only ten gave a history of hav- 
ing in the past had regular employment. 

FIFTY DEPENDENT JEWISH FAMILIES 

These families composed 212 individuals, ranging in age from six to 68 
years. 

One hundred and eighty-one were suffering from physical defects or 
disease, or showed disturbances of physical health. 

The average mental age was less than 11 years. 

Sixty-two and three-tenths per cent suffered from character defects or 
personality difficulties. 

Fifty per cent were classified as being either subnormal in intelligence, 
of borderline mental defect, feebleminded, psychopathic or suffering from 
epilepsy, endocrine disorders, mental disease or psychoneurosis. 

Twenty-five were found to be totally illiterate, and 30 had never entered 
any kind of a school. 

Behavior difficulties — misconduct — appeared in 28 cases. 

More than half were American born. 

ASSOCIATED CHARITIES 
122 Relief Cases 

One hundred and twenty-two relief cases were studied. One hundred and 
twenty were native born; 98 of native-born parents. 

Thirty-six were in such poor physical condition as to be in urgent need 
of medical attention. 

One hundred and four had been married; 21 were widowed and 16 
separated or divorced. 

The median mental age was 11 years; they were all adults. 

Approximately 72 per cent were classified as either subnormal in intelli- 
gence, mentally defective, psychopathic personality or suffering from endocrine 
disorders or from mental disease. 

Twenty-two persons had been arrested. 

None of those classed as cases of borderline mental defect, feebleminded, 
psychoneurotic, epilepsy or mental disease had ever been regularly employed 
in their lives. 

Only one out of the 36 in poor physical condition had been regularly 
employed. 

ASSOCIATED CHARITIES 

100 Unemployment Cases 

Ninety-two were men and eight were women; 83 were white and 17 were 
negroes; 94 were native born, 68 of native-born parents. 

Thirty-five had become dependent during the last year and 42 were 
non-dependent. 

Thirty-eight were married. 

The median mental age for the group was 12 years; they were all adults. 

Seventy-one were classified as either sub-normal in intelligence, mentally 
defective, psychopathic personality or suffering from epilepsy, endocrine 
disorder, or mental disease. 

Ninety were unskilled workers. 



58 MENTAL HYGIENE SURVEY OF CINCINNATI 

THE CITY INFIRMARY 
394 Cases 

The range of ages was from 26 to 110 years, with only 10 under 40 years. 
The vast majority were between 55 and 85 years. 

Two hundred and twenty-two of the 394 persons were in such physical 
condition as to be in urgent need of medical treatment. 

Two hundred and forty-six were native born, but only 66 were of native 
parentage. 

One hundred and one have been dependent from two to five years; 101 
from six to nine years, 88 from 10 to 20 years, and 29, 20 years and over. 
(Record not obtained on remaining cases.) 

Two hundred and seven of the 394 had been married. 

One hundred and twenty-six gave a history of past behavior difficulties, 
such as fighting, sex promiscuity, alcoholism, etc. One hundred and twelve 
had been arrested; 63 were repeaters. 

Only 32 individuals had been skilled workers. 
Only 20.3 per cent of the white inmates were classed as "normal," while 
of the 39 negroes only three were normal. 

HAMILTON COUNTY HOME 
162 Cases 

The median age was 70 to 74 years. The vast majority were between 60 
and 80 years. Only six were in good physical condition. 

Ninety-three out of the 162 were native born, 50 of native-born parents. 

Sixty-eight had been married, 15 of whom had separated or divorced. 

Thirty-five inmates had shown delinquent tendencies. 

Seventeen were skilled workers, 129 unskilled, and six had never done 
any work. 

Only four and five-tenths of the whites were classed as of normal men 
tality; all the rest showed serious mental abnormality. All of the negroes 
were either feebleminded or cases of mental disease. 



PUBLIC SCHOOL CHILDREN 

This survey included a study of 4,326 public school children in Cincinnati. 
The idea was to get a picture of the average public school child. In order to 
do this, certain typical schools were chosen, and every child in these schools 
was given an examination. The schools selected by Mrs. Helen Woolley, Direc- 
tor of the Vocation Bureau, at the time that the survey was inaugurated, were 
as follows: Washington, Peaslee, Washburn, Twenty-third District, Avondale. 

The survey included a careful physical examination of each child. This 
was done by the City Department of Health. Great appreciation and commen- 
dation is due to the officials of the Health Department, for the splendid piece 
of work they have done in connection with this phase of the survey. The size 
of the report makes it impossible to present properly all of this valuable 
material. 

The mental examination of the children was conducted in the following 
way: an intelligence rating was secured by means of group tests, except in the 
case of the youngest children, who were all given individual, psychological 
examinations. A personality evaluation was made through a history gathered 
from the child and the teacher and through social investigations. The behavior 
of the child was studied in the same way; while an educational rating was 
made from the school records already at hand, and through conferences with 
teachers. 

After gathering this routine data on each child, every case history was then 
carefully gone over and all children showing conduct disorders, personality 



MENTAL HYGIENE SURVEY OF CINCINNATI 59 

difficulties, intellectual retardation, school retardation, speech defects, etc., 
were given intensive psychiatric and psychological examinations. 

ANALYSIS OF DATA GATHERED 

Of the 4,326 children studied 4,155 were native born. The fathers of 3,142 
children were American born, the mothers of 3,299 were American born; while 
in the case of 2,945, both parents were American born. In the case of 84 
children information was not obtained. There were 4,055 white children, and 
271 colored. 

There are two ways of considering the problem of school efficiency; one 
from the standpoint of the product, i. e., is the school doing all it can to develop 
each child to the fullest extent of its possibilities; the other from the stand- 
point of administrative efficiency, i. e., is the school being most economically 
run? The two points of view are inextricably bound up in each other; any 
investment, no matter how small, in a poor school system is money wasted; 
and the taxpayers will have to pay out later in charities, dependent and feeble- 
minded institutions, and penitentiaries what they so shortsightedly hold back 
now. On the other hand, almost any amount of money expended upon a well 
run school system will not only yield enormous returns in an efficient citizenry, 
but will, in the long run actually save money. 

Take, for example, the following table: 

TABLE 30 
Number of Grades Repeated Classified With Reference to Mental Diagnosis 

Un- Total 
Four as- Re- 
or cer- peat- 
Diagnosis Total None One Two Three More t'n'd. ters 

Normal 3003 2234 642 58 5 2 62 707 

Dull normal 741 181 387 134 18 1 20 540 

Subnormal 208 25 90 71 17 3 2 181 

Borderline mental defect 86 10 33 27 11 1 4 72 

Mental defect 86 8 22 28 16 10 2 76 

Pre-psychopathic 69 29 20 13 3 .. 4 36 

Psychopathic personality 47 11 16 15 1 2 2 34 

Nervous and neurotic 36 21 6 6 1 2 13 

Question of epilepsy 3 1 2 2 

Epilepsy 9 4 3 1 1 .. .. 5 

Endocrine disorder 29 13 11 2 3 .. .. 16 

Unascertained 9 6 3 3 

TOTAL 4326 2543 1235 355 76 19 98 1685 

We find that 1,685 children, or 39 per cent of the total number, repeated 
over 2,250 grades. Figuring the approximate average cost per pupil per grade 
at $63.62, we get a total of $143,000 expended on repetition of grades alone. 

And how does this react upon the school children themselves? The repeat- 
ers, if normal — and 707 of them were — going over the same work a second or 
third time lose interest not only in their studies, but in the school as a whole. 
Inattentiveness and misbehavior develop, and, combined with a bad attitude 
toward the school, increases the difficulties of the teachers manifold. Where 
the repeaters are subnormal, they remain in the same grade year after year, 
absorbing nothing themselves and acting as a drag on the progress of their 
more normal classmates. The element of discouragement due to a failure to 
make grades has an immense effect on the personality of the child. 

Table 31 shows more specifically the effect of this repitition on the normal 
child who makes his grade each year. 



60 MENTAL HYGIENE SURVEY OF CINCINNATI 

TABLE 31 
Chronological Age of Children Classified According to Grade Attained in School 

Grade Attained Total 5 6 7 8 9 10 11 12 13 14 15 16 17 



Kindergarten 2 2 

First grade 683 28 368 213 51 13 2 4 2 1 ... 1 

Second grade 609 .. . 20 298 187 64 26 7 3 4 

Third grade 549 31 241 161 76 24 10 4 ... 2 

Fourth grade 601 1 49 221 172 103 33 17 3 2 

Fifth grade 546 1 1 30 173 176 98 45 19 2 1 

Sixth grade 531 4 42 159 138 108 57 21 2 

Seventh Grade 324 1 ... 16 119 103 62 22 1 

Eighth Grade 331 3 25 127 102 62 11 

Vocational, Pre-vocational, Household Arts and Commercial Classes 

Sixth grade 38 7 16 12 3 

Seventh grade 45 14 14 14 3 

Eighth grade 34 4 14 11 5 

Ninth grade 19 1 16 2 

Observation and Oppor- 
tunity classes 14 2 4 8 ' 



TOTAL 4326 28 388 548 533 502 491 492 427 434 288 165 28 1 

The range of chronological ages in each grade shows a variation of from 
six to eight years. In the first grade we have children of five and children of 
13 in the same classroom. In the fifth grade the situation is even worse, the 
range of ages extending from seven to 16. This is pernicious, regardless of the 
mentality of the children. More than mental age must be taken into considera- 
tion in grouping boys and girls. A child of 10 and a child of 15 may have the 
same mental age, but physiologically and emotionally they are entirely differ- 
ent. The influence of a backward boy or girl of 15 on a normal one of 10 
is likely to be anything but good as far as habits and general behavior are 
concerned. 

Table 32 brings out another point in regard to this indiscriminate grouping 
of children: 

TABLE 32 

Retardation and Advancement of School Children With Reference to Grade 

Attained 

Retarded Advanced 

, a ^ f * v Total Total 

Grades 5 or At Years Re- Ad- 
Total more 4 3 2 1 Age 12 3 tarded v'c'd. 

First 683 8 2 13 51 213 368 28 287 28 

Second 609 7 7 26 64 187 298 20 291 20 

Third 549 6 10 24 76 161 241 31 277 31 

Fourth 601 2 3 17 33 103 172 221 49 1 158 271 

Fifth 546 1 2 19 45 103 176 168 30 2 170 200 

Sixth 531 ... 2 21 57 108 138 159 42 4 188 205 

Seventh 324 1 22 62 103 119 16 1 85 136 

Eighth 331 1 11 62 102 127 25 3 74 155 

TOTAL ..4174 24 ~26 122 359 999 1598 873 162 IT 1530 1046 

Here we note a total of 1,046, or 25.1 per cent advanced for their ages. 
These bright children suffer in several ways besides those mentioned above. 
Their classmates offer little stimulus to them mentally, and the work, held back 
for the slower ones, is often so easy for them that they become lazy and 
superficial and fall far short of their possibilities. Because of this incomplete 
claiming of their attention, they constitute no mean percentage of our behavior 
problems. 



MENTAL HYGIENE SURVEY OF CINCINNATI 



61 



TABLE 33 

Chronological Age of Children Classified With Reference to Test Age* 



Test Age 


Total 


5 


S 


7 


8 


9 


10 


11 


12 


13 


14 


15 


16 17 




17 


10 5 
32 49 
15 137 


2 

12 

108 


3 
19 


1 
11 


2 














V " 


97 




VI " 


292 




VII " 


377 


3 


54 


173 


93 


29 


13 


3 


5 


2 




2 




VIII " 


449 




11 


60 


148 


105 


58 


32 


17 


8 


6 


4 




IX " 


477 




2 


20 


98 


109 


88 


67 


34 


34 


20 


4 


1 ... 


X " 


449 




1 


6 


57 


98 


88 


73 


44 


35 


27 


15 


5 ... 


XI " 


338 








5 


34 


56 


65 


61 


50 


44 


19 


4 ... 


XII " 


300 








2 


15 


43 


59 


70 


51 


36 


20 


4 ... 


XIII " 


191 






1 


1 


3 


23 


24 


51 


37 


33 


17 


1 ... 


XIV " 


116 










4 


11 


13 


28 


33 


15 


9 


2 1 


XV " 


62 










1 

1 


2 

1 


7 
2 
3 

1 
1 


20 

16 

6 

3 


15 
9 
4 


12 
11 


5 
5 




XVI " 




1 


XVII " 


13 




XVIII " 


4 




XIX " 


1 




Unascertained 


1097 


13 1 


86 


193 


144 


144 


119 


121 


76 


58 


29 


13 


1 ... 


TOTAL 


4326 


73 4 


45 


575 


570 


555 


504 


471 


431 


336 


233 


113 


19 1 



Table 34 shows the mental retardation and advancement in terms of 
years. 

TABLE 34 
MENTAL RETARDATION AND ADVANCEMENT 

At age 880 

Retarded 1 year 680 

2 years 339 

3 years 196 

4 years 107 

5 years 52 

Over five years 24 

TOTAL RETARDED 1398 

Advanced 1 year 541 

2 years 246 

3 years 93 

" 4 years 44 

Over 4 years 27 

TOTAL ADVANCED....~951 



Approximately one-fourth of the children were at age in the sense of 
having the same mental and chronological ages; and this does not mean merely 
difference in mental age, but difference in interests, attitude, aptitude, inclina- 
tion, etc. A boy of 14, five years retarded, is certainly not the equal of a bright, 
intelligent boy of nine years at age. 

*NOTE: Of the 3,229 children whose test ages were determined, 880 or 27.3 
per cent had test ages which coincided with their chronological ages; 951 
or 29.5 per cent were over age mentally, and the remaining 1398 or 43.3 per cent 
were retarded from one to eight years. 



62 MENTAL HYGIENE SURVEY OF CINCINNATI 

TABLE 35 

MENTAL DIAGNOSIS 

Diagnosis 

TOTAL WHITE COLORED 

Number Per Cent Number Per Cent Number Per Cent 

Normal ;3003 69.4 2894 71.4 109 40.2 

Dull normal 741 17.1 667 16.4 74 27.3 

Subnormal 208 4.8 167 4.1 41 15.1 

Borderline mental defect... 86 2.0 68 1.7 18 6.6 

Mental defect 86 2.0 66 1.6 20 7.4 

Pre-psychopathic 69 1.6 66 1.6 3 1.1 

Psychopathic personality . . 47 1.1 45 1.1 2 0.7 

Nervous and neurotic 36 0.8 35 0.9 1 0.4 

Question of epilepsy 3 0.1 2 0.0 1 0.4 

Epilepsy 9 0.2 8 0.2 1 0.4 

Endocrine disorder 29 0.7 29 0.7 

Unascertained 9 0.2 8 0.2 1 0.4 

TOTAL 4326 1000 4055 KKU) ~271 m0 

This table shows that two per cent of the children were classified as 
mental defectives (one and six-tenths per cent of the whites and seven and 
four-tenths per cent of the colored children were considered mentally defec- 
tive); two per cent were classified as cases of borderline mental defect (one 
and seven-tenths per cent of the whites and six and six-tenths per cent of the 
colored) ; three and five-tenths per cent of the total number of children were 
diagnosed as either nervous, pre-psychopathic or psychopathic; four and eight- 
tenths per cent were diagnosed as subnormal (four and one-tenth per cent of 
the whites and 15.1 per cent of the colored) ; two-tenths per cent were classi- 
fied as epileptics; and seven-tenths were classified as cases of endocrine dis- 
order. 

MENTAL CONDITIONS FOUND AMONG SCHOOL CHILDREN 

There are five distinct types of problem children to which we wish to call 
special attention in this phase of our report: The retarded child, the mental 
defective, the nervous and psychopathic child, the epileptic child, and the child 
suffering from speech defect. 

THE RETARDED CHILD 

The dull and subnormal child, whose mental backwardness is not of such 
a degree as to require special class training with the feebleminded, but who, 
because of his retarded mentality, is in need of more specialized training than 
he can secure in the regular grade, is the type referred to here. It is this type 
of pupil for whom the ungraded classes were created. 

In the great majority of these children, the chances for normal develop- 
ment and mental health are probably good, provided early and proper diagnosis 
is made and suitable treatment and training are instituted. 

Every backward child should receive a complete physical and mental ex- 
amination and home investigation. Proper study and treatment of the causes 
underlying the mental backwardness of these children frequently serve to 
return them to the regular grades. 

In life the mental equipment of the backward child is not quite sufficient to 
enable him to measure up to the complex demands made upon him, and a large 
proportion of the failures and breakdowns are drawn from this group. And 
yet we find among the retarded children the same ambition and the same striv- 
ing for success as the more normally endowed show. 

The particular difficulties and varied problems presented by these individ- 
uals are not to be solved by merely determining their intellectual rating and 
I. Q. We must know the causes of the mental retardation and not rest satis- 



MENTAL HYGIENE SURVEY OF CINCINNATI 



lied with merely identifying and measuring the degree of backwardness. Each 
case is an individual problem, presenting varied medical, psychological, socio- 
logical and pedagogical angles. 

Four and eight-tenths per cent of these children were diagnosed subnormal, 
and 17.1 per cent were called dull normal. 

THE NERVOUS AND PSYCHOPATHIC CHILD 

This type of child is neither insane nor feebleminded. He may have good 
intelligence and would often be classed on purely an intellectual basis as 
normal, yet these children furnish the most difficult problems to be met with in 
the public schools, and in later life are one of the largest sources of delin- 
quency and insanity. 

These children show outstanding handicaps of personality that mark them 
as being different from other children. Their adaptative difficulties are the 
expression of mental attitudes, mental trends and twists which constitute a 
very marked departure from normal mental health. 

Various types of psychopathic children are to be seen in the public schools, 
the very thin, under-nourished, overactive, restless, neurotic emotional, violent 
tempered child; the apathetic, weak-willed, physically inert, sluggish, over- 
suggestible, inadequate child; the egocentric, selfish, egoistic, unappreciative, 
cruel, ungrateful, individualistic child; the shut-in, self-centered unapproach- 
able child; the timid, hypersensitive child with feelings of inferiority, and 
many other types with psychopathic traits that seriously handicap them in 
adapting themselves to their environment. 

We shall not endeavor to go into the many causes for these conditions. 
They are varied and are found within the individual himself (in disorders of 
the physical organism, in mental conflicts, etc.), or are environmental in origin 
(factors in the home, in the school, at work and at play.) We do wish to 
emphasize, however, the importance of early recognition of these psychopathic 
conditions among school children. Daily it is becoming more and more appar- 
ent that many adult breakdowns are directly traceable to child life. A psycho- 
pathic personality forms the very richest soil possible for insanity in adoles- 
ence and in adult life, and is a very large factor in juvenile delinquency. 

With our changing attitude towards insanity and crime, with our present 
realization that these conditions often show their beginnings in childhood and 
are, in a large measure, preventable, there can be no excuse for our neglect to 
deal intelligently and understandingly with psychopathic children in the public 
schools. The examination of these children should be conducted in a clinic 
equipped to deal with both mental and physical issues. The great importance 
of a searching physical investigation is now made evident from the frequency 
with which disorders of the ductless glands, ovaries, testicles, thyroid, etc., are 
encountered. These children should receive a thorough-going study from a 
psychiatric as well as a psychological point of view. The question of psychotic 
and psycho-neurotic tendencies, the child's personality make-up, his abilities 
and disabilities should all receive careful consideration. A course of treatment 
for each psychopathic child should be mapped out only after such a compre- 
hensive examination has been made. 

Three and five-tenths per cent of the public school children examined came 
within this particular grouping. If this percentage is borne out among the entire 
population of public school childen, and we believe it is, then it can be seen 
how important is this -problem; how urgent is the need of adequate clinical 
facilities for dealing with the problems these children present if we are to 
prevent behavior difficulties later on. 

THE MENTALLY DEFECTIVE CHILD 

Two per cent of the public school children studied were classified as men- 
tally defective, while an additional two per cent were diagnosed as cases of 
borderline mental defect. 

The import of these figures cannot be ignored. There is no more import- 
ant problem for the school authorities of Cincinnati than that of mental 



64 MENTAL HYGIENE SURVEY OF CINCINNATI 

deficiency. The feebleminded child is not only a misfit in the school, a burden 
to the teacher, and a hindrance to the other pupils in the school, but later on in 
life the sad combination of his childish mind and adult years brings him into 
conflict with society's customs and laws. 

The fact that this is an hereditary condition, and the fact that mental 
defectives, for the most part, if untrained, become dependents and delinquents, 
while if properly trained along industrial and vocational lines they may be, 
in a large measure, made self-supporting, puts a serious responsibility on the 
shoulders of public school officials. 

As it has been brought out in our previous discussion, feeblemindedness is 
one of the large factors underlying pauperism and dependency, and is import- 
ant to consider in connection with delinquency. These feebleminded individ- 
uals are costing the state vast sums of money and are reproducing their kind 
in large numbers without hindrance and sending them out into the community. 
If we are to do anything to prevent these conditions, the time to accomplish 
this is during the early years of the school career. The keynote to the solution 
of the problem of feeblemindedness is early and intensive industrial and voca- 
tional training* during developmental years, at a time when the feebleminded 
child can profit by what we do for him. This can be accomplished only by 
state-wide organization of special classes for all defective children in the pub- 
lic schools, and by the equipment of the state institutions for the feebleminded 
with educational facilities to meet the problems of those children who cannot 
be trained in the public schools, or are delinquent and dependent defectives. 

The present institutional facilities in this state for the care of feebleminded 
children are inadequate. A large number of the mentally defective children in 
the community will, of course, require a period of institutional care and 
intensive training. In the meantime and for many years to come, the only 
training the great majority will ever receive will be in the public schools of 
the state. This much must be borne in mind; mental defectives are trainable, 
if trained along proper lines, to work with their hands, to do something useful 
at which they can earn a living. 

Nothing worth while can ever be accomplished by academic training of 
feebleminded children. The vast financial burden and social mischief for 
which these individuals are responsible are, in a large measure preventable, 
providing we train defective children along industrial and occupational lines in 
the public schools and in the state institutions, and providing we give them that 
kindly supervision they are in need of when they leave the public schools, and 
providing we early send to the state institutions those defecive children who 
threaten to become delinquent and dependent. 

THE EPILEPTIC CHILD 

The frequency of this condition in childhood is not definitely known owing 
to the difficulties of making a diagnosis. In a survey of this kind only the gross 
cases with definite histories of seizures and clinical evidence of epilepsy could 
be included. In this particular survey, two-tenths per cent were diagnosed as 
suffering from epilepsy. This is practically the same as findings in other sur- 
veys, particularly Wisconsin and South Carolina. Approximately two out of 
every thousand public school children are suffering from epilepsy. Some of 
these children are feebleminded and yet, because of their epileptic attacks, can- 
not be handled in special classes with mental defectives. Many of them, before 
repeated seizures have produced mental dullness, are of normal intelligence and 
are capable of keeping up with the regular grade work. But it is necessary 
to exclude them from the grades for the sake of other children as well as for 
the welfare of the epileptics themselves. Nothing is more distressing for the 
other children than to witness the severe convulsions from which these chil- 
dren suffer. As a result, the epileptic child is, in a large measure, excluded 
from the public schools, and he grows up in life having to face a double handi- 
cap — not only the affliction of his disease, but the additional burden of illit- 
eracy. Special provision for the teaching of these children should be made. 
Many of them may be saved for useful work in life, for some are exceptionally 



MENTAL HYGIENE SURVEY OF CINCINNATI 



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MENTAL HYGIENE SURVEY OF CINCINNATI 



capable individuals. It is believed that, through the careful training of these 
children from childhood, much of the personality defect, as well as the 
danger of intellectual deterioriation may, in a measure, be prevented. 

SPEECH DEFECT 

Six and one-tenth per cent of the school children examined were found to 
be suffering from some form of speech defect. We are here dealing with 
children who, in the great majority of instances, have good intelligence and 
learning capacity, and who are capable, if given the right help at the right 
time, of becoming successful men and women, but if their handicap is not 
early recognized and properly treated, they may become social failures because 
of their inability to meet people and situations in life. The constant embarrass- 
ment and shame resulting from stammering or stuttering or some other speech 
difficulty, brings about a consciousness of inferiority that destroys the very 
foundation of self-confidence and self-assurance. Table 36 shows the fre- 
quency of speech disorders among the school children studied. 

The chief problem presented by these children is one of emotional insta- 
bility and personality difficulties. These conditions are largely modifiable, but 
if not properly treated at an early period, they remain throughout life. 
Speech classes should be organized only under the direction of highly trained 
speech teachers. These children should not need to be removed from the 
grades, but at some period during each day they should be excused from their 
regular work for a conference and for special treatment by the speech teacher. 

PERSONALITY DIFFICULTIES 

We may regard the personality difficulties as the covert mechanisms that 
sooner or later issue in overt behavior. These difficulties are found in mental 
attitude and in mental adjustments. Table 37 shows the frequency of person- 
ality handicaps and their relation to the mental diagnosis. 

TABLE 37 
Personality Types of Children Classified According to Mental Diagnosis 



Diagnosis 






Normal 3003 



Dull normal 

Subnormal 

Borderline mental defect. 

Mental defect 

Pre-psychopalhic , 

Psychopathic personality. 
Nervous and neurotic..... 

Question of Epilepsy 

Epilepsy , 

Endocrine disorder 

Unascertained 



741 

208 



23G5 

436 

78 

27 

22 

1 

5 
2 
3 
5 
6 



396 

127 

45 

20 

18 

43 

23 

28 

1 

2 

17 



71 

117 

49 

31 

34 

2 

2 



22 



4 20 

1 10 

11 



TOTAL 4326 



2950 



720 



128 



313 



39 



67 



100 



It is interesting to note that 19.3 per cent of the children classed as 
normal, 60.1 per cent of the children classed as subnormal, 65.1 per cent in the 
borderline mental defect group, 69.8 per cent of the feebleminded, and all of 
the cases of psychopathic personality showed character defects and personality 
handicaps. This certainly points to an explanation, in a measure at least, of 
the fact that defective and psychopathic children are liable later on in life to 



MENTAL HYGIENE SURVEY OF CINCINNATI 67 

provide us with such a large percentage of cases of dependency and delin- 
quency. 

One of the things that stand out in this table is the relatively large per- 
centage of inadequate personalities found in the dull, subnormal and feeble- 
minded children. 

CONDUCT DISORDERS 

One of the most serious conditions threatening childhood is the danger of 
entering upon criminal careers. Disorders of conduct that lead to delinquency 
show themselves very early in the school period. Such socially unacceptable 
behavior as persistent lying and stealing, cruelty, fighting, bad sex practices, 
and truancy, are not uncommonly met with in the public schools. If misunder- 
stood and unintelligently handled, these conditions may eventually develop 
into more serious departures from normal behavior, and sooner or later the 
individual is hailed into the Juvenile Court. 

As we have previously pointed out, the majority of all criminal careers 
have their beginnings in childhood. The realization of this fact is causing 
public authorities and those interested in the prevention of crime to advocate 
the importance of centering all constructive social work on those forces that 
train children for a wholesome and socialized adult life. 

Six and two-tenths per cent of the children in this study showed such 
outstanding disorders of conduct as clearly to depart from average normal 
behavior. It is not surprising to find that while only three and three-tenths per 
cent of the normal children had conduct disorders, 13.9 per cent of the sub- 
normal children, 14 per cent of the feebleminded children and 43.4 per cent of 
the nervous and psychopathic children had repeatedly exhibited socially unac- 
ceptable behavior. This certainly shows where our future problem of delin- 
quency lies. 

It may be remarked that practically all of the children exhibiting behavior 
difficulties were found to be handicapped in the way of character traits and 
personality make-up. The solution of the problems presented by these children 
will never be accomplished by grouping them into types and giving them classi- 
fications. Each and every individual is a complex problem unto himself, to be 
unravelled and adjusted only after the most painstaking and scientific inquiry. 
It is here that a well-rounded clinical study, plus the help of the visiting 
teacher can be of incalculable service, not only to the school authorities in 
adjusting the child to the curriculum of the school, but — and this is of greater 
importance — in setting in motion machinery looking to the normal adjustment 
of the child to life. 

PHYSICAL CONDITION OF SCHOOL CHILDREN 

No mental hygiene survey is complete without a physical examination of 
the children studied. Mental health and physical health are so essentially 
inter-dependent that they cannot be considered separately. Many cases of 
mental dullness are undoubtedly physical in origin and recoverable. The 
influence of fatigue, physical illness, and poor nutrition in causing psychopathic 
conditions is now well known. The physical make-up of the individual is pro- 
bably the foundation of his personality. 

The urgent need of clinical facilities, not only for the diagnosis, treatment, 
and prevention of conditions that affect the mental health of public-school chil- 
dren, but for the recognition of gross physical conditions, which are undoubt- 
edly often causative factors of mental ill health and mental maladjustment, 
and are the forerunners of grave physical diseases in adult life, is now being 
generally stressed. 

Table 38 shows the physical condition of these children. 



MENTAL HYGIENE SURVEY OF CINCINNATI 



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MENTAL HYGIENE SURVEY OF CINCINNATI 69 

Approximately 66 per cent of these public school children were suffering 
from physical disease or defect or showed evidences of physical ill health. 

That there is a relation between physical health and school retardation is 
evident from the fact that 47.4 per cent of those in poor health had repeated 
grades. 

One out of every four children diagnosed as being either "nervous" or 
psychopathic was in such poor physical health as to be in urgent need of 
medical attention. A great many other "nervous" and psychopathic children 
were in poor physical condition but were not as serious problems. We could 
state that under all conditions the "nervous" and psychopathic child is chiefly a 
medical problem. (By this we mean a problem for psychiatric consideration.) 

Nine hundred and twenty-seven children had defective teeth. The length 
of this report will not permit of our going into details regarding this condition. 
More and more it is becoming evident that defective teeth are the source of 
many obscure conditions. The public is now becoming well informed as to the 
serious consequences that may result from neglected teeth. We know that 
infections of internal organs may insidiously take place and result in serious 
disturbances of health. 

Eight hundred and thirty-four children showed marked eye conditions. 
In cases of defective vision, it is far more humane, and certainly more eco- 
nomical, to have children's eyes tested and glasses provided than to leave them 
handicapped and backward as a result of conditions that are remedial. Defec- 
tive eyes with imperfect vision cause headaches, blurring of sight, and often 
serious attacks of eye strain, with nausea and dizziness, and lead to serious 
retardation in school. 

Four hundred and thirty-four children were suffering from malnutrition. 
It is impossible in this report to give the proper consideration to this most 
important condition, a condition that is so fundamental in maintaining good 
physical or mental health. The effects of malnutrition on the physical and 
mental make-up of the child have been shown in this survey to be great. Milk 
campaigns throughout the country, and general education by public health 
authorities bearing upon the causes of this condition are now attracting wide- 
spread interest. 

The great frequency of endocrine disorders, diseases of the ductless glands, 
heart trouble and other conditions, would certainly justify a special discussion. 
However we can only emphasize and stress the value of public health inspec- 
tion and medical examination of public school children. This is certainly fun- 
damental to any well rounded mental hygiene program. 

COMPARATIVE STATISTICS ON TWO SCHOOLS 

Very naturally the various schools we studied showed some striking 
differences. Avondale and Washington may be taken as examples. 

In the Avondale School 46.4 per cent of the children' were advanced in 
grade for their ages; while only 12.7 per cent were retarded for their age. In 
the Washington School practically the opposite was found. Only 14.5 per cent 
were advanced; while 48.4 per cent were retarded. Another interesting find- 
ing is that in Avondale four per cent of the children attended irregularly; 
while at the Washington 18.6 per cent attended irregularly. 

The physical condition of the children in the two schools showed different 
results. Fifty-four and nine-tenths per cent of the children in the Avondale 
School showed some physical defect or some evidence of physical disease or 
ill health; while approximately 71 per cent of the children in the Washington 
School showed physical defects or some physical disease or ill health. 

Twenty-six per cent of the children in the Avondale School repeated 
grades; while 46.6 per cent in the Washington School repeated grades. 

Only two-tenths per cent of the children in the Avondale School were 
mentally defective, while three and one-tenth per cent of the children in the 
Washington School were mentally defective. 



70 MENTAL HYGIENE SURVEY OF CINCINNATI 

NUMBER OF CHILDREN IN FAMILY 

The first community of which any child is a member is the family into 
which he is born. The success or failure of the relationships established 
between child and parent, and between the child and his brothers and sisters, 
will be a determining influence in later successes or failures of social adjust- 
ment in the larger groups of which he will be a member. The size of the 
family — that is, the number of other children within the household with 
whom the problem child will have to build up definite relationships — is, there- 
fore, a matter of interest. 

This study shows that less than one-fourth of the feebleminded children 
come from families of as few as one or two children; nearly one-half of the 
psychopathic children come from families of as few as one or two children. 
Twenty-five per cent of the mentally defective children came from families 
where there were more than six children; only eight per cent of the psycho- 
paths came from such large families. The average number of children in the 
family of the mental defectives was five. 

Only two per cent of the mentally defective children had no brothers or 
sisters; 22 per cent of the psychopaths were only children. Of the 40 psy- 
chopathic children, more than half were found to have been either only chil- 
dren for the first five years of their lives, or to have been the youngest child 
in the family, with at least six years intervening between the births of the last 
two children. 

SOCIAL MALADJUSTMENTS IN THE FAMILY 

We have used the term "social maladjustments" in a rather broad sense. 
We have intended it to include a great variety of conditions, feeblemindedness, 
insanity, epilepsy, physical disease — such as tuberculosis, syphilis, etc. — delin- 
quency, alcoholism, family desertion and non-support, extreme cruelty, person- 
ality difficulties in members of the family, marked retardation in school, 
dependency — either partial or complete, etc. 

The average number of social maladjustments in the families of the fee- 
bleminded and psychopathic school children was approximately the same, in 
each case being slightly over three. It is only when the various types of 
maladjustment are studied separately that more significant facts are revealed. 

The families showing insanity, extreme cruelty, or alcoholism, and con- 
taining members exhibiting serious personality difficulties, were almost invaria- 
bly in the cases of the psychopathic school children. The two cases of suicide 
noted were parents of psychopathic children. Approximately 50 per cent of the 
families of the psychopathic children studied, have had contact with the social 
agencies registering in the Confidential Exchange. 

Sixty-two per cent of the families of the mentally defective school children 
have records with some social agency in Cincinnati. In the families of this 
particular group of defective children investigated, we found 65 mentally 
defective brothers and sisters, diagnosed as such by the Vocation Bureau. 
In addition, there were 87 brothers and sisters who were markedly retarded 
when they were in school and who had been considered subnormal. 

Thirty-eight per cent of the families studied were found to have had regis- 
trations in agencies dealing with problems of health; 30 per cent had regis- 
trations in agencies dealing with dependency; 26 per cent had registrations 
in agencies dealing with delinquency. 

HOME AND NEIGHBORHOOD INDEX 

A numerical value was given each home and neighborhood in order to 
evaluate statistically the data secured. The scale standardized by the Cali- 
fornia Bureau of Juvenile Research was used by the social workers on the 
Survey Staff, and the following material was worked up on the basis of this 
scale. 

♦See Research Bulletin Number 7 and 3, California Bureau of Juvenile Research, Whittier, 
Calif, . , ^ .. 



MENTAL HYGIENE SURVEY OF CINCINNATI 71 

The great frequency of "nervous" and psychopathic children, however, is 
manifest at the Avondale School. Seven and one-tenth per cent of the children 
in this school were classified as being "nervous" or psychopathic, while only 
two and four-tenths per cent of the children in the Washington School were 
psychopathic. It would seem that in one school we are dealing with a matter 
of intellectual retardation, and in the other school we are dealing with 
"nervous" and psychopathic conditions. 

THE SOCIAL ENVIRONMENT OF THE PROBLEM SCHOOL 

CHILD 

Two hundred and seventy-four children received a careful social investi- 
gation. These were all children who had been diagnosed by the Survey Staff 
as being either feebleminded, psychopathic or suffering from epilepsy. 

We assumed that a mere cross-section study such as was secured in our 
physical, psychiatric and psychological examinations, could not give all of the 
facts, and sometimes the most important facts, to be considered in connection 
even with mentally defective and epileptic children, to say nothing of the 
cases of psychopathic personality. 

The type of home, the intelligence and fairness of parental control, the 
recreational facilities, and the like, must necessarily be important factors in 
influencing the development of the mental life of the child. 

In securing information, the mother was interviewed and an attempt was 
also made to see the father and other relatives or neighbors. 

The educational, occupational, and health history of the mother and father, 
brothers and sisters, of each child was secured. Court and institutional records, 
as well as a history of mental or physical disease or defect in the family, were 
noted. The personal history of the child, including prenatal, birth, and 
developmental conditions, was secured. A record of past illnesses and of pres- 
ent physical and mental condition was made. There was a careful inquiry 
into the child's personal habits and peculiarities; also a history of his past 
behavior. 

Each case was cleared through the Confidential Exchange, and on all 
families for which social agencies had registrations, the records were read 
and any history of delinquency or dependency was noted. 

When all possible information had been secured in regard to the child 
and his environment, an index of numerical value was placed upon his home 
and the neighborhood in which he lived. 

For most of the discussion of the problem school child a division has been 
made into two large groups: first, the children who gave evidence of mental 
defect; second, the children who were diagnosed as "nervous" and psy- 
chopathic. These children always showed personality difficulties and fre- 
quently conduct disorders. 

Careful social investigations were made for the 147 included in the first 
group, and for 91 of the second group; also for 12 epileptics. In the case of 
24 children, it was impossible to secure sufficient information to enable us to 
include them in this phase of the study. 

GUARDIANSHIP CONDITIONS OF THE CHILD 

There are no relationships in a child's life that are more important than 
that between the child and its parents. If the original home has been broken 
by separation of the parents, the child is left not only under abnormal condi- 
tions in regard to guardianship, but he has often passed through an emotional 
experience that may place a mark upon his mental life not easily to be effaced. 

One out of every three children diagnosed as cases of psychopathic person- 
ality, come from homes in which the child's own mother and father are not 
living together. The psychopathic children, more frequently than the defec- 
tive, or the normal children, live in homes where a remarriage of either parent 
has taken place. There were more than twice as many psychopathic children 
living in homes with other relatives than there were defectives. 



72 MENTAL HYGIENE SURVEY OF CINCINNATI _ 

HOME INDEX 

For the home index information obtained by the investigator is divided 
into five parts or items. They are as follows: 

1. Necessities: the status of the home with reference to the ordinary 
needs of life; income, food and clothing, shelter, etc. 

2. Neatness: the order and taste in which the home is arranged; 
also its conditions from the standpoint of sanitation and health. 

3. Size: relative size with reference to the number of persons 
living in the home. 

4. Parental conditions: the intelligence of the parents in the sense 
of social adaptability, the extent to which they are living together, and 
the degree of harmony which usually prevails. 

5. Parental supervision: the extent to which the parents (or guar- 
dians) exercise their jurisdiction over the physical, mental and moral 
welfare of the children; the quality and fairness of this control. 

After the data for all items are recorded, each item is given a grade, 
on the scale of five points, according to its agreement with published standards. 
A perfect score would then be five on each of the five items, making a total 
index of 25. The lowest score would be one on each item with an index of five. 

The general social level of the home is summarized in this final index. 
Furthermore, an analysis of the values given — the various items which, added 
together, make the final index — frequently shows at what point certain homes 
are consistently failing, or at what point other homes are particularly success- 
ful. As the scale has been standardized and used in other investigations, a 
home scoring over 20 points is considered favorable on the whole to the best 
interests of the child. A home scoring below nine is of a very low social level. 
Eighteen has proved to be the score which most frequently represents the 
typical middle-class home. 

As a result of scoring the homes of the problem school children, it was 
found that six per cent of the children lived in homes that received an index of 
21 or above; 11 per cent lived in homes scoring less than nine. The median 
home index (the point above and below which 50 per cent of the cases lay) 
for the whole group was 14. These measurements furnish a general picture 
of the home situations surrounding these 274 problem school children. A few 
lived in homes that may be considered favorable to the best interests of the 
child; many lived in homes of the very lowest social level; the greatest number 
lived in homes that were midway between typical middle-class homes and 
those with distinctly unfavorable conditions for the child. To illustrate the 
conditions that surround a child in a home receiving an index between 13 
and 16, the following typical case is given: 

FRANK— white; age, 14. 

Diagnosis — Psychopathic personality — emotional. 

Neighborhood Index — 13. 

Home Index — 14. Divided among the following items: 

Necessities — 3. Father is a switchman earning $110.00 a month. Sufficient food and 
clothing. Rooms are furnished with cheap, but substantial furniture, a few rugs 
and pictures. Home fairly comfortable. 
Neatness— 3. Rooms clean but not very well arranged. Inadequate plumbing. Rooms 

very disorderly in the morning, usually in fair order by afternoon. 
Size— 3. Mother, father and Frank live in four small rooms on second floor of tenement. 

No yard. 
Parental Condition — 2. Mother and father both stopped school before reaching fifth 
grade. Father is quick-tempered. No actual rupture between parents, but frequent 
quarrels. Mother is at home most of the time, but exercises little control over the 
boy. 
Parental Supervision — 3. Mother particularly interested in boy, but is emotional and 
physically weak. Father is very severe at times. Little attempt is made to super- 
vise evenings or Sunday amusements. 

At no point does this home give evidence of utter failure, yet the general 
picture is that of a home which has little help to offer to a boy who has well 



MENTAL HYGIENE SURVEY OF CINCINNATI 73 

developed personality difficulties, and has become a behavior problem in school. 

One-third of all the mentally defective, psychopathic, and epileptic school 
children whose social environment was studied, live in homes that score 
between 12 and 16 and so may be considered to present in general similar 
pictures. Over half of them live in homes that score less than 13 and so give 
evidence of more unfavorable conditions for the best interests of the child. 

In homes scoring less than nine, the children are faced daily by condi- 
tions that almost defy description. 

IDA— White; age. 10. 
Diagnosis — Mental defective. 
Personality — Emotional. 
Neighborhood Index — 12. 
Home Index — 7. 

Necessities — 1. Father an unskilled day laborer. Children all undernourished. Furniture 
is inadequate and in need of repair. No rugs or pictures. Clothing is dirty and 
insufficient. Family has received material relief from three social agencies. Income 
insufficient for needs of family. 
Neatness — 1. Rooms are filthy and dark. Rags, empty cans, broken dishes in one corner 
of the room. Food and dirty dishes piled on chairs and table. Two beds in the 
room where the cooking and eating is done unmade at five in the afternoon. 
No yard. Brick area way dirty and piled with trash. 
Size — 1. Mother, father and four children live in two rooms in a tenement. Halls are 

dark and narrow. No place except the streets for play. 
Parental Conditions — 2. Father is illiterate, but patient and sensible. Mother has tuber- 
culosis and is very neurotic; seems incapable of carrying on a consecutive con- 
versation. Fair degree of harmony. Both parents present in the home. 
Parental Supervision — 2. Father interested in the children and attempts to supervise 
their activities. Mother is incapable of direction or discipline. Two older children 
have been in Juvenile Court for minor delinquencies. 

This ten-year-old mentally defective girl has so far presented no problem 
to the community except that of school retardation. She is now repeating the 
first grade for the third time. Personality difficulties have already developed, 
however, and as adolescence is reached, will probably become accentuated. 
Little in her home will contribute to a solution of her problems. Handicapped 
by intellectual defect, suffering from personality difficulties, living in a home 
that is one of squalor and filth, the future of the girl can be predicted with a 
fair degree of certainty. A mind capable of normal adult judgments, an 
emotional life well ordered and under control, or a social environment that 
would help and not hinder — if any one of these were to be hers, the social prog- 
nosis in the case would not be so hopeless. 

The final index, the result of evaluating the various elements in the home, 
gives an indication of the general situation that exists there. The mental 
defective who comes from a home that scores 22 would seem to have a much 
better chance of making satisfactory social adjustments than the mental defec- 
tive coming from a home with an index of seven. However, significant psychi- 
atric implications are revealed only when the index is analyzed. A home may 
have an index of nineteen, receiving the highest score (five) on necessities, 
neatness, and size, and yet secure but a score of two on the two items that 
deal with parental conditions and supervision. The home of a child, high- 
strung and neurotic, may offer everything needful in the way of physical com- 
fort and convenience, and yet fail at the point that will most intimately affect 
his mental health and adjustment. 

To secure a more definite picture of the general conditions that surround 
the problem children of the schools, the values placed upon the homes have 
been studied for each school district. 

These investigations were carried on in five school districts, to be desig- 
nated as Districts A, B, C, D and E. 

In District A the homes are almost entirely tenements. There are few 
one-family houses and congestion is the outstanding characteristic. The peo- 
ple of the district are largely foreigners from South European countries and 
from Germany. There are only a few colored families. The wage earners are 
unskilled laborers, with a very few shopkeepers. 



74 MENTAL HYGIENE SURVEY OF CINCINNATI _^ 

In District B unskilled laborers with about the same wage scale as in 
District A are found. There are many negroes, a large number of Russian 
Jews, and some Italians, as well as a few native born Americans. Many of 
them live in small houses set close together, others in tenements. The district 
as a whole is not as congested as District A. 

The school populuation of District G is largely native-born of German 
parents. The homes are two and three-family houses with only a few tene- 
ments in the whole district. Skilled laborers and shopkeepers and some cleri- 
cal workers live here. Probaby this district is more nearly a community than 
any other one of the districts in which we worked. 

District D is made up largely of native-born Americans living in one-family 
houses, many of them owned by the occupants. Clerical workers, store-keep- 
ers, highly skilled laborers, and men managing small business concerns are 
residents of this district. Typical middle-class homes are the rule. 

District E is the hardest to describe because there is the widest variation 
in the type of homes and the type of individuals living there. There is a small 
colored community, there are a number of foreign born, non-English-speaking 
small-shop owners, and there are homes of many of the wealthiest people of 
the city, all in this one district. 

A comparison of the 266 home indices secured in these various districts 
is interesting. No home grading over 20 was found in District A. No home 
grading under nine was found in Districts D or E. If the colored homes are 
eliminated from the study of District E, over one-third of the children came 
from homes scoring over 20. 

In District B over one-fifth of the children came from homes scoring less 
than nine, and in District A, one-eighth of the children came from such homes. 
This score indicates the lowest social status. 

DIAGNOSIS AND HOME INDEX 

Disregarding entirely the district from which the problem school children 
come, a comparison of the home indices for the two groups of children — those 
who were mentally defective and those who were psychopathic — was made. 

Twelve per cent of the psychopathic individuals live in homes scoring 
over 20; 3 per cent of the mental defectives lived in such homes. Only three 
psychopathic children were found in homes scoring less than nine; nearly one- 
fifth of all the mental defectives lived under these most unfortunate conditions. 
Many of the defective school children were handicapped by defective social 
environment as well as by defective heredity. As has been stated before, now* 
ever, only a hint of the psychiatric implications is secured from the home 
index. 

It is in the analysis of the index, in the study of what elements are lacking 
in certain homes and what elements are present, that the value and significance 
of the measurement of the immediate environment is revealed. 

Since each home was scored on five points, — necessities, neatness, size, 
parental conditions and parental supervision — a study was made of the values 
given each of these elements in the home index. For purposes of contrast, the 
scores placed upon the various items in the homes of the mentally defective 
school children and of the psychopaths, are presented together in Table 39. 

TABLE 39 

ANALYSIS OF HOME INDEX 

Mental Defectives 

















Parental 


Parental 


Score 


Necessities 


Neatness 


Size 


Conditions 


Supervision 


Given 


No. 


% 


No. 


% 


No. 


% 


No. 


% 


No. % 


5 


11 


7.6 


16 


11.0 


7 


4.8 





0.0 


1 0.7 


4 


20 


13.8 


31 


21.4 


28 


19.3 


10 


6.9 


16 11.0 


3 


56 


38.6 


31 


21.4 


33 


22.8 


48 


33.1 


45 31.0 


2 


41 


28.3 


38 


26.2 


55 


37.9 


68 


46.9 


63 43.5 


1 


17 


11.7 


29 


20.0 


22 


15.2 


19 


13.1 


20 13.8 



Total ..145 100.0 145 100.0 145 100.0 145 100.0 145 100.0 



MENTAL HYGIENE SURVEY OF CINCINNATI 75 











Psychopaths 






















Parental 


Parental 


Score 


Necessities 


Neatness 


Size 


Conditions 


Supervision 


Given 


No. 


% 


No. 


% 


No. 


% 


No. 


% 


No. % 


5 


16 


18.6 


18 


20.9 


15 


17.4 


1 


1.2 


1 1.2 


4 


13 


15.1 


17 


19.8 


17 


19.8 


15 


17.4 


12 13.9 


3 


32 


37.2 


30 


34.9 


26 


30.2 


35 


40.7 


43 50.0 


2 


24 


27.9 


18 


20.9 


25 


29.1 


23 


26.7 


23 26.7 


1 


1 


1.2 


3 


3.5 


3 


3.5 


12 


13.9 


7 8.1 


Total , 


.."86 


Si 


~86 


100.0 


~86 


100.0 


1*6 


100.0 


86 100.0 



On every point, it will be observed, the psychopaths come more frequently 
from homes scoring five and less frequently from homes scoring one — this with 
one significant exception. On the item "parental condition," we find a larger 
percentage of psychopaths than of mental defectives coming from homes given 
the lowest possible score. In determing the value to be given this item, the 
social adaptability of the parents, the harmony that usually prevails in the 
home, the adequacy of the arrangements that have been made in case one or 
both parents are permanently absent, are all taken into account. It is certainly 
of outstanding significance that the children most handicapped by emotional 
maladjustments came more frequently than did any other group of problem 
school children from homes where these elements in the home situation were 
either entirely lacking or were unsatisfactory. 

ANALYSIS OF HOME INDICES OF PSYCHOPATHIC CHILDREN 

The chief value of anaylsis of the home indices does not come from a con- 
trast of two groups that vary so widely both in the psychiatric and social 
problems that they present, but from a study of the varying scores placed upon 
the items in the homes within each group. To learn at what points the homes 
of psychopaths were consistently deficient, and at what points there was but 
infrequent failure, should both contribute to our understanding of this inter- 
esting group of children and aid in the formulation of a program to bring 
mental good health to many of them. 

On the first three items evaluated, which cover the immediate physical 
surroundings of the child, few homes were found that were markedly defi- 
cient. Only one home scored one on necessities (that of a colored family) and 
only three homes scored one on either neatness or size. Housing conditions 
for these children were not entirely satisfactory, however, since 29 per cent 
lived in homes that gave evidence of definite overcrowding. 

For the last two items of the scale "parental condition" and "parental 
supervision" — a very different situation existed. Twelve homes received the 
absolute minimum on the first point; seven homes received the minimum on 
the second point. A score of less than three on either of these two factors 
which so intimately affect the life of the emotionally maladjusted child indi- 
cates that most unfortunate conditions surround him and greatly increase the 
difficulty of social adjustment. 

Forty per cent of the homes from which the psychopaths came received 
a score of less than three on "parental conditions;" 35 per cent received a score 
of less than three on "parental supervision." 

We cannot say definitely whether the failure of the homes of the psycho- 
pathic children on these two points may serve primarily as an explanation 
of the beginning of the child's difficulties, or acts as an aggravation of already 
well developed handicaps. Our figures secured for the whole group and from 
a study of individual cases indicate that there is an intimate relation between 
these deficiencies in the home and the maladjustment of the child. 

RUTH— White; age, 13. 

Diagnosis — Psychopath. Personality — emotional and egocentric. 

Neighborhood Index — 20. 

Home Index — 18 (necessities — i; neatness— 5; size— 5; parental conditions— 1 ; parental 
supervision — 3) . 



76 MENTAL HYGIENE SURVEY OF CINCINNATI 

It will be noted that there is no marked deficiency in the physical surroundings of the 
child. The chief failure in the home lies in "parental conditions," and there is an indication 
of inadequate supervision 

Personal History and Present Situation. Ruth, who is illegitimate, is now living with 
an aunt and uncle. She has never been told why she is not living with her mother. Her 

mother is know as Mrs. , lives in Cincinnati, and the child visits her several 

times during the year. The mother makes no attempt to understand the child and is indif- 
ferent to her. The aunt and uncle with whom Ruth lives are both neurotic and irritable 
There are no other children in the house. The aunt is a nurse and goes out on cases. Ruth 
is, therefore, alone much of the time. She admits that she broods over why she is not living 
with her mother. She creates fantasies to explain the situation, but is not satisfied and 
wants to "know." She has witnessed an entire lack of self-control on the part of her guar- 
dians, and she frankly states that she employs temper tantrums to obtain anything she desires 
that has been denied her. The aunt and uncle are much interested in the girl and attempt 
to exercise supervision over her. Their entire lack of appreciation of her difficulties, how- 
ever, makes the supervision ineffectual. 

This case has been chosen not because it is particularly striking, but as an 
illustration of how the failure of one element in the home situation may fre- 
quently be the prime determinant of a child's mental ill health. It has been 
offered not as an elaborate individual case study, but merely as one of many 
short studies made of the social environment of psychopathic children. Most; 
of these indicate a failure at the same point — "parental conditions." Any 
adequate program for coping with this particular type of problem child in 
the school must take into account this failure in the home. Special classes 
without psychiatric social service will in many cases prove inadequate. Since 
the guardianship and supervision of these emotionally unstable and inadequate 
children is found to be unsatisfactory in so large a number of cases, the com- 
munity, for its own protection, should undertake to supply the deficiency. 

ANALYSIS OF HOME INDICES OF MENTALLY DEFECTIVE CHILDREN 

It will be remembered that when the values placed upon the various items 
in the home score were contrasted for the two large groups of problem school 
children, on every point except one, lower values were the rule for the homes 
of the feebleminded children than for those of the psychopaths. We know, 
therefore, that in general unfavorable conditions for the best interests of the 
child are present in most of these homes, but the chief concern of those inter 
ested in the development of a program looking toward the satisfactory adjust- 
ment of the mental defectives in the community is to discover on what points 
the failure of their homes is most marked. Since each of the five items in the 
scale are scored on the basis of five — that number representing highly favor- 
able conditions in the home, one representing most unfavorable conditions, with 
four, three and two representing varying degrees of favorability — we are jus- 
tified in stating that any home that scores less than three on any item is 
markedly deficient in that one respect at least. The first three items cover the 
physical equipment of the home. On the first, "necessities," 40 per cent of the 
homes scored less than three; on "neatness," 46 per cent, and on "size," 53 
per cent have the two lowest scores. Overcrowding, with the resulting lack 
of privacy and opportunity for recreation in the home, is the chief failure in 
the immediate physical surroundings of these feebleminded children. For both 
items, "parental conditions" and "parental supervision," 60 per cent of the 
homes scored less than three, and so give evidence of distinctly unfavorable 
conditions surrounding the child. 

At present there are special classes for defectives in the schools. In 
these classes specific training is given to the end that these mentally handi- 
capped children may be socially and economically competent. From a study 
of the homes in which the mentally defective school children live, it seems 
obvious that more intensive school training is necessary to achieve the desired 
end. The general picture presented by the whole group of mental defectives, 
and the detailed picture presented by particular cases, both emphasize the 
need of social supervision from the psychiatric point of view, as well as for 
special training. 

ETHEL— White; age, 14. 

Diagnosis — mental defect. No outstanding personality difficulties. 



_ MENTAL HYGIENE SURVEY OF CINCINNATI 77 

Neighborhood Index — 14. 

Home Index — 9 (necessities — 3; neatness — 1; size — 2; parental conditions — 2; parental 

supervision — 1. 
Family History and Present Situation. Father is a boilermaker and makes good wages. 
He is alcoholic and syphilitic. Mother is shiftless and markedly inadequate in her reactions. 
Of the 6 children, 4 have had mental examinations — 2 are feebleminded, one is a borderline 
mental defective, one is subnormal ; one cousin is feebleminded. The parents and 6 children 
live in a four-room, unpainted house. The rooms are dirty and ill-kept. The yard is piled 
with heaps of junk. The sheds and barns are in a filthy condition. An older sister, who is 
of defective mentality, has had an illegitimate child. The mother accepts the sex delinquency 
of the daughter without a qualm, and no effort is made to supervise Ethel, who has begun 
to "go with the boys." 

When Ethel is questioned, she says: "I've got to get away from the house once in a while. 
I can't even find a place to sit down there." 

Ethel may never become a serious problem to the community. She is a 
high-grade mental defective without personality difficulties. She is taking a 
special household arts course in school and is doing well in it. Nevertheless, 
it is impossible to regard her future except with misgiving. She is attractive 
and eager for "good times." She is dissatisfied with the home. She realizes 
that her sister's "mistake" is regarded lightly and without concern by members 
of the family. She is already planning for the time when she can leave school 
and get a job. "I'll have better times then." This girl needs kindly, but firm 
and intelligent supervision. 

If her inadequate judgments could be supplemented by those of an adult 
for whom she had respect and liking, and who was fully conscious of the 
social and psychiatric implications in the case, the social prognosis would be 
more hopeful. 

Of all the homes of mentally defective school children that were visited 
during the course of this investigation, one-fifth were found to be filthy, dis- 
orderly, and unsanitary. Half gave evidence of serious overcrowding. Only 
in rare instances were conditions in any way satisfactory in regard to super- 
vision, interest and understanding of the child's problem. 

An educational program for this group of problem children of the schools 
that does not take fully into account these conditions in the home will be dis- 
appointing in its results. Guidance after leaving school is an important as 
training in school. A noteworthy beginning has been made in Cincinnati in 
the working out of this further problem by the Vocation Bureau. All children 
passing through the Placement Office who are known to be feebleminded are 
placed under definite supervision as long as they remain in industry. 

NEIGHBORHOOD INDEX 

The social environment of every child is found both in the home and in 
the neighborhood in which he lives. The home may be favorable to the best 
interests of the child and the neighborhood may be unfavorable, the situation 
may be reversed, or both may be favorable. But, whatever the combination, 
each will contribute a definite share to the determing of the child's mental 
make-up and social reaction. 

In the study of the home of the problem children, each home was scored 
on specified items and a final index was secured. For the evaluation of the 
neighborhood in which these children live, the same system was used. 
The neighborhood is graded upon the basis of five points: 

1. Neatness, sanitation, improvements (the status of the neighbor- 
hood with reference to general appearance, cleanliness, sanitary equip- 
ment, and modern improvements.) 

2. Recreational facilities (the extent to which provision is made for 
recreation in the home and neighborhood.) 

3. Institutions and establishments (the kind and value of educa- 
tional, industrial and social institutions in the neighborhood, with special 
reference to their probable moral effect on the neighborhood.) 

4. Social status of residents (educational, vocational and moral con- 
ditions — including standards of living.) 



78 MENTAL HYGIENE SURVEY OF CINCINNATI 

5. Average quality of homes (an estimate of the probable range 
of home indices which would be given if each home were scored as 
carefully as the one home visited.) 

Each of the five items is graded on a scale of five points, one point 
representing decidedly unfavorable conditions; five points representing fav- 
erable conditions; and two, three and four representing conditions of varied 
favorability between the two extremes. After each item has been graded, the 
five scores are added and the sum stands as the neighborhood index. If a 
neighborhood index is over 20 points, it indicates as a general classification 
that very good conditions prevail; an index between nine and thirteen indi- 
cates poor conditions. All scores under nine indicate that most unfavorable 
conditions for the best interests of the child are present. 

The distribution of the total number of neighborhood scores is given 
in table 40. 

TABLE 40— DISTRIBUTION OF NEIGHBORHOOD INDICES 



Neighborhood 






Index 


Number 


Per Cent 


25 


12 


4.4 


24 


7 


2.6 


23 


2 


0.7 


22 





, . 


21 





. . 


20 


1 


0.4 


19 


1 


0.4 


18 


23 


8.4 


17 


8 


2.9 


16 


41 


15.0 


15 


50 


18.2 


14 


15 


5.5 


13 


74 


27.0 


12 


12 


4.4 


11 


5 


1.8 


10 


6 


2.2 


9 


6 


2.2 


8 


8 


2.9 


7 


3 

.... 274 


1.1 


TOTAL. . . 


100.0 



Seven per cent of the neighborhoods in which the problem school chil- 
dren lived were in the highest group, 14 per cent lived in neighborhoods scor- 
ing less than 13, which indicates unfavorable conditions. The median neigh- 
borhood index _was 15. 

There is a marked variation in the neighborhood indices given in the dif- 
ferent school districts. The most frequent score ranged from thirteen in one 
district to 25 in another. Since there was this wide variation in the values 
placed upon the neighborhoods in the different districts, a comparative study 
was made for each school of the scores for the mental defectives and for 
the psychopathic school children. 

In only one district did a larger proportion of the mental defectives than 
of the psychopaths come from the better neighborhoods of the district. In 
the other four districts a very much larger percentage of the psychopaths 
were found in these better neighborhoods. 

The families of the mentally defective school children, content with less, 
shift into the least desirable sections of these school districts. Not only do 
defectives come from defective homes, but in many instances, they seek 
defective neighborhoods. Th mentally defective child is faced by an environ- 
ment in home and in neighborhood, that, day after day, brings into his life all 
those influences that will make socially acceptable conduct well-nigh impossi- 



MENTAL HYGIENE SURVEY OF CINCINNATI 79 

ble, and few of the better influences that will aid in his difficult problems of 
adjustment. 

ROY and EDWIN— (brothers)— Colored; age 6 and 7. 

Diagnosis — mental defect. 

Home Index — 8 (necessities — 1; neatness — 1; size — 3; parental conditions — 2; parental 

supervision — 1) . 
The father died of delirium tremens, and the stepfather has deserted the mother. The 
only income is the money which the mother makes as a scrub woman. Her brother 
lives in the home and has most of the care of the boys. The mother is disagree- 
able, whining, and given to sudden gusts of temper. She has been sexually 
promiscuous. 
Neighborhood Index — 8. 

Neatness, Sanitation and Improvements — 2. 

A row of ill-kept houses built close together. Small front yards strewn with rubbish. 
Rough pavement in which were pools of water thrown out from the houses after 
having been used for washing. Streets poorly lighted. 
Recreational Facilities — 2. No recreation in the home. A playground six blocks away. 

Cheap amusements within two blocks. 
Institutions and Establishments — 2. No provisions for social life of colored residents 

of districts. 
Social Status of Residents — 1. Many illiterates, unskilled laborers; both white and 

colored prostitutes. Noisy and disreputable neighborhood. 
Average Quality of Homes — 1. Few homes in the immediate vicinity would score more 
than 9. The home visited was apparently no Worse than others in the neighborhood. 

The two boys, one in the kindergarten, the other in the first grade, are both 
serious behavior problems. They are quarrelsome, restless and troublesome. 
In the class room they are noisy, rude and bold. Both of them disseminate 
perverted sex information. At home they are stubborn and disobedient. Both 
are feebleminded with marked personality difficulties. They live in a home 
where sex delinquency is present. They live in a neighborhood where there 
are many prostitutes. Neither the home nor the community is at the present 
time offering any adequate supervision in the helpful solution of the problems 
these boys present. 

Early diagnosis has been secured, but unless it is followed by proper 
supervision and adequate training, nothing will have been gained. It can be 
predicted almost without qualification that unless such supervision is provided, 
ten years from now both will have been guilty of serious social misconduct, 
and will be in need of placement in a custodial or correctional institution. 

THE EPILEPTIC SCHOOL CHILD 

In the five schools in which examinations were conducted, twelve children 
were found to be suffering from epilepsy. Too often it is forgotten how great 
is the handicap in each one of these cases — how almost invariably the individ- 
ual's life is nothing but a tragedy of continued attempts and failures to make 
proper adjustments. A psychiatric social investigation was made in each case, 
to determine, if possible, what elements in the environment would help or 
hinder in the difficult problems of establishing these children as socially 
acceptable members of the community. 

Nothing of particular note in regard to the guardianship of these children 
was found. Nine were living in homes in which both father and mother were 
present; three were living with one parent alone, or with one parent and a 
step-parent. 

No one of these children was an only child, but the families from which 
they come are not large. 

The maladjustments noted in these 12 families all come under four general 
heads — serious physical disability, outstanding behavior difficulties, evidence 
of mental defect, and alcoholism. Four of these epileptic children have broth- 
ers diagnosed as feebleminded. The mother of one gave a history of marked 
retardation in school. Two cases of alcoholism and one case of insanity were 
noted in the immediate family of one individual. 

Six of the children diagnosed epileptics are also suffering from personality 
and behavior difficulties. It was noted that the number of maladjustments 



80 MENTAL HYGIENE SURVEY OF CINCINNATI 

in the families of these six were greater than in the families of those who 
were not handicapped by personality difficulties. 

In general the families of these epileptic children can be called neither 
better or worse than the families of the other problem school children. 

HOME AND NEIGHBORHOOD INDEX 

As in all other cases, a numerical value was placed on each home and 
neighborhood from which these children came. 

The distribution of these values is in general the same as for the total 
number of problem school children studied. Only two epileptic children came 
from homes that gave evidence of offering conditions in any way favorable to 
the best interests of the child. The four who came from homes that may 
be definitely classified as unfavorable, have shown behavior difficulties as 
well as epilepsy. 

In no case does the home of an epileptic child receive the highest grade- 
five — on any one of the items scored. The chief points of failure in the immed- 
iate environment are found in the crowded, unsanitary and disorderly condi- 
tions of the home. , 

THE R FAMILY 

The many angles of the problem presented by these children, the cost in 
time and money, the social callousness that permits them to drift from agency 
to agency until they have become unimprovable, may be illustrated in the case 
of the R family. 

This family first came to the attention of the Survey Staff at one of the schools where 
Ella was examined and diagnosed as psychopathic with borderline mental defect. Such a 
diagnosis placed her in the group for psychiatric social investigation. This investigation re- 
vealed the following situation, as to home and neighborhood conditions. 

Home Index — 7 (necessities — 2; neatness — 1; size — 2; parental conditions — 2; parental 
supervision — 1.) 

Neighborhood Index — 16 (sanitation — 4; recreational facilities — 3; social institutions — 3; 
Social status of residents — 3; average grade of homes — 3). 

It is evident that we have a very lowgrade home, deficient in nearly every respect. The 
chief deficiencies, however, are in the neatness and order of the home, and in parental super- 
vision. It was learned that Ella's mother had died of influenza in 1918, and that the 13-year-old 
Ella was endeavoring to manage the household, consisting of her father and 2 younger 
brothers. The father was a butcher who was indifferent to the children and inadequate in 
every respect as regards the home. The reason for the two low scores becomes evident. 
Already the lack of adequate supervision in the home had produced its effect; an older sister,, 
Edna, had been a sex delinquent since 1919 (the mother died in 1918), and was at the Girls' 
Opportunity Farm. Before going into the ramifications of this family history, we will give 
the personal history and the clinical findings. 

Personal History. Ella was the fifth child in a family of ten children, 13 years and 
6 months old, in the sixth grade, having repeated the second and fourth. 

Clinical Findings. Physical condition, good; condition of jaw caused Ella to drool at 
the mouth occasionally. Mental age, 10 years and 11 months, I. Q. 70. Personality, inadequate 
— weak-willed, suggestible. At the time of the examination, Ella was apathetic and indif- 
ferent. She was self-conscious regarding the malformation of her jaw, about which she had 
been much teased. After having spent several years at various orphanages, she was now 
at home trying to carry the burden of a family never too well established, but now rendered 
rudderless by the death of the mother. An older sister had already become submerged and 
was an inmate of a correctional institution. 

We have here a picture of a defective girl, handicapped physically, mentally, and so- 
cially. 

The family next came to the attention of the Survey Staff at one of the orphanages, where 
two of the children were discovered; the family had been broken up and the children scat- 
tered. In rapid succession the remaining children were discovered by the Survey Staff as in- 
mates of two other orphanages. Finally the climax was reached when Ella herself was dis- 
covered by the examining staff at the Girls' Opportunity Farm where she had succeeded her 
sister. She had become a sex delinquent. The clinical examination and personal history at 
the farm gave somewhat different results than the examination some months before at the 
school. For one thing it revealed the fact that Ella had become infected with both syphilis 
and gonorrhea. 

Her personal history revealed that she had been handled by orphanages and agencies 
as follows: orphanage— 2 months; orphanage— 1 year; orphanage— 1 year; uncle— 6 months; 
placed with four different families; Opportunity Farm for the last 4 months. 

The orphanages had found it impossible to place her in a foster home because of her 
physical handicap, which rendered her repugnant. For the same reason one of the orphanages 



MENTAL HYGIENE SURVEY OF CINCINNATI 81 

had refused to keep her. Her sex delinquency had presented no dramatic incidents and was 
the expected consequence in a defective, inadequate girl. 

The Clinical examinations by members of the Survey Staff, of Ella's brothers and sisters 
had revealed that two were cases of borderline mental defect and two were cases of subnormal 
intelligence. Another brother had also become delinquent, was in the Boys' Special School 
because of chronic truancy, and had been diagnosed mentally defective by the Vocation 
Bureau. 

We have in this family of delinquents, two whose misconduct was of so serious a nature 
as to result in commitment to a correctional institution. There is a constant history of 
dependency. Investigation revealed that this family have had contacts with ten social agen- 
cies in Cincinnati, divided as follows: 2 agencies dealing with dependency (not including 
orphanages), 3 agencies dealing with delinquency, 5 agencies dealing with health. It should 
be noted that the delinquent careers of these children all began after the year of the mother's 
death. 

The picture is appalling. The futility of that sort of social work which deals with end 
results instead of fundamental causes is illustrated. 

As a problem in dependency, the family was mishandled. In delinquency the family 
became a problem also. The greatest oversight, however, becomes evident when it is under- 
stood that the development of these problems might have been predicted long before. The 
family is undoubtedly from defective stock. However, it was kept together with a fair 
degree of success during the lifetime of the mother, although it must be noted that the 
family had applied even then to social agencies for help, thus bringing it into contact with 
organized social effort. The deterioration of the family was rapid after the death of the 
mother. The score of the home indicates defective elements, and the added defects of insuf- 
ficient parental supervision develop the potential delinquency and dependency in the children. 
Mental diagnosis resulting in psychiatric social interference at any stage of the history might 
have saved the family to the community. It certainly would have saved the organized 
social agencies money. 

SUMMARY OF STUDY OF PUBLIC SCHOOL CHILDREN 

The survey included a study of 4,326 public school children in Cincinnati. 
Four thousand one hundred and fifty-five were native born. There were 4,055 
white children and 271 colored children in the group studied. 

Thirty-nine per cent repeated over 2,250 grades at an estimated cost of 
$143,000. 

The range of chronological ages in each grade showed a variation of from 
six to eight years. 

Twenty-five and one-tenth per cent were advanced for their ages, accord- 
ing to grade, while 36.6 per cent were retarded according to grade for age. 

Twenty-seven and three-tenths per cent had test ages that coincided with 
their chronological ages; 29.5 per cent were over age mentally, and the 
remaining 43.3 per cent were retarded from one to eight years mentally. 

Two per cent were classified as feebleminded, two per cent as cases of 
borderline mental defect, three and five-tenths per cent as either nervous or 
psychopathic, four and eight-tenths per cent as subnormal, two-tenths per cent 
as cases of epilepsy, and seven-tenths per cent as suffering from endocrine 
disorder. 

Nineteen and three-tenths per cent of the children classed as normal, 60.1 
per cent of the children classed as subnormal, 65.1 per cent of the cases of 
borderline mental defect, 46.5 per cent of the feebleminded and all of the cases 
of psychopathic personality snowed character defects and personality handi- 
caps. This in a measure explains why it is from these groups that we largely 
draw our delinquent, dependent and socially maladjusted individuals. 

Six and two-tenths per cent of the children studied showed such outstand- 
ing disorders of conduct as clearly to depart from average normal behavior. 
It is not surprising to find that while only three and three-tenths per cent of 
the normal children had conduct disorders, 13.9 per cent of the subnormal 
children, 14 per cent of the feebleminded children, and 43.4 per cent of the 
"nervous" and psychopathic children had repeatedly exhibited socially unac- 
ceptable behavior. This finding certainly points out in the direction in which 
our delinquency problem lies. 

Approximately 66 per cent — two-thirds of the group — were suffering from 
physical disease or defect or showed evidence of some physical ill health. 

A study of 274 feebleminded, psychopathic and epileptic school children 
was made which included a very thorough investigation of their environments 



82 MENTAL HYGIENE SURVEY OF CINCINNATI 

and their home and living conditions. It may be noted that 62 per cent of the 
families of the feebleminded school children have records with social agencies 
in Cincinnati, while approximately half of the families of psychopathic chil- 
dren have come in contact with social agencies. 

Of the 274 feebleminded, psychopathic and epileptic children upon whom 
social investigations were made, 38 per cent of the families had registrations 
from agencies dealing with problems of health; 30 per cent had registrations 
from agencies dealing with dependency, 26 per cent had registrations from 
agencies dealing with delinquency. 

A numerical index was given to home and neighborhood, rated on various 
different points which are explained fully in the text. 

Forty per cent of the homes from which the psychopathic children come 
received a very low score on parental conditions, (harmony, adaptability, intel- 
ligence, understanding, etc.); in 35 per cent of the homes of psychopathic 
children an exceedingly low score was given to proper home control, parental 
supervision, guidance and training. 

In the homes of feebleminded children, almost half scored exceedingly low 
on simple necessities in the way of food, clothing, heat, etc.; 46 per cent of 
the homes of the feebleminded children received the very lowest possible 
score on sanitation, and the ordinary minimum health requirements for living 
conditions. In the homes of the feebleminded persons, 53 per cent received 
the very lowest score possible on size, there being great overcrowding, lack 
of privacy, etc.; 60 per cent of the homes of the feebleminded children received 
exceedingly low scores on parental conditions, parental supervision and con- 
trol, and moral training. 

These findings were practically repeated in our social investigation of the 
homes of epileptic children. 

SPECIAL CLASSES 

The public school system of Cincinnati ranks ahead of those of most 
cities in the number and kinds of special classes that it has, to take care of 
the misfits in the regular school population, who, because of mental or physi- 
cal defects or language difficulties, are unable to hold their places alongside of 
the normal child. In this system the following kinds of special classes 
are included: 

1. Classes for Mental Defectives. 

2. Observation Classes. 

3. Opportunity Classes. 

4. Pre-vocational or Industrial Classes. 

5. Classes for Delinquents, including the Boys' Special School and the 
schools at the Girls' and Boys' Opportunity Farms. 

6. Conservation of Vision Classes, including the Blind Classes. 

7. Oral Classes. 

8. Open Air Classes, including the Classes for the Pre-tuberculous Chil- 
dren at the Branch Hospital. 

9. Classes for Crippled Children at the General Hospital. 
10. Classes for Foreigners. 

(1) The first single class for mentally defective children was organized in 
1909. Since then the need for these classes has grown to such an extent that they 
now occupy an entire school building; in addition to this there is a separate 
class in each of six of the regular schools. The average attendance in November 
of this year was 379. For this number of pupils there are 22 teachers and one 
supervisor, making an average of about 17 pupils to the teacher. The salary 
of these teachers is the same as that of the public school teacher — that is a 
minumum of $1,100 for a normal school graduate, $1,200 for a college graduate, 
and an increase of $100 each year until a maximum of $2,000 is reached. The 
supervisor is on a regular principal's salary which has as its maximum $3,500. 
About three-fourths of the teachers have had special training for their work 



MENTAL HYGIENE SURVEY OF CINCINNATI 83 

either at the Vineland Training School for the Feebleminded or at the New 
York University Summer School or at the Cincinnati University. 

The pupils for this special school are selected by the Vocation Bureau 
and only those who are definitely defective are sent to it — that is, the highest 
group are those whose mental ages as adults will not be much above 10 years. 
Usually the lowest grade children who are sent to the school have intelligence 
quotients of about 50. The Vocation Bureau sends to the school a report of the 
mental condition of each child, and at first he is placed in the grade which this 
report would indicate was proper for him. The placing according to grades 
is very flexible, however, as the children are taught as individuals, and a pupil 
may do first grade arithmetic, second grade reading and seventh grade man- 
ual training. About 50 per cent of the school day is given over to academic 
work. The boys have manual training (wood work) one hour a day, the 
girls cooking, sewing and laundry work two hours a day. One-half hour 
each day is given over to physical training; music (rote singing) also furnishes 
part of the program. Sense training is emphasized among the younger chil- 
dren, for which the Montessori materials are used. Stress is laid on the 
teaching of personal habits of cleanliness and decency, and each child is 
required to take at least one bath a week in the school showers. Another 
interesting feature of the day's work is the luncheon program when a five- 
cent hot lunch is served. The older girls and boys wait on the tables and the 
teachers eat with the children and instruct them in the correct way to eat 
and conduct themselves at the table. All of the academic training is exceed- 
ingly practical and an effort is made to relate all of the child's work to 
the problems of everyday life. For instance, in arithmetic the child is almost 
never given mere abstract problems. Instead, he is taught to make change for 
purchases and to figure out how much so many yards of cloth ought to cost. 
In the custodial class, where the children are low-grade defectives, very little 
academic work is attempted, most of the time being given over to training in 
personal habits, sense training and rhythmic games. The pupils are not seated 
at regular school desks. There are four large tables in each room with four 
children sitting at each table. This allows for an informal conducting of 
classes. 

The separate school building in which most of these classes are held is 
an old building, but it tontains a fairly well equipped, though rather small 
gymnasium, a shower room, a manual-training room with equipment for all 
kinds of wood-work, and a domestic-science room for cooking and laundry 
work. 

In the twelve years since the Special School was started, it has developed 
into a very efficient school using all the modern methods and theories of edu- 
cating the feebleminded. Every effort is made to teach these unfortunate 
children to take their places in the community and to become as useful citi- 
zens as is possible with their low mentality. The effort to place the children 
in industry as they leave the school is done through the Vocation Bureau. 

(2) The observation classes were established to take care of the bad 
academic failures in the first and second grades, who when tested by the 
Vocation Bureau, were found not to be defective. There are in the city three 
observation classes located in three different schools, with a total average 
attendance of 61 pupils and three teachers. The teachers of these groups are 
unusually resourceful elementary school teachers, and with the average of 20 
children to a teacher, they are able to make their instruction more individual. 
The course of study is practically the same as that given in the regular school 
grades. The pupils may be passed back to the regular school classes at any 
time during the year if the teacher considers that they can do the work of 
their regular grade. 

The first year that the observation class was started, 14 children were 
placed under a very good teacher in the Peaslee school. Of this group four 
proved to be defective. Two did three year's work during the first year of the 
class and were entered in the fourth grade the following year; three did two 
years' work in one year and were entered in the third grade; one did a little 



84 MiENTAL HYGIENE SU3RVEY OF CINCINNATI 

over one year's work and was entered in the second grade. The remaining 
four continued in the Observation class another year. Thus the idea is to 
eliminate the school retardation due to some maladjustment other than mental 
defect, which is so frequent in the lower grades, and to keep this type of 
retarded child from being a misfit all through his school life because of failure 
in the first and second grades. 

(3) The term "opportunity class" has been applied to a variety of classes. 
In most of the classes they exist from the third to the fifth grades. They are 
intended for children who are more retarded academically than mentally and 
can be expected to make more than average progress for a time, and also for 
children who, though not actually defective, are so mentally inferior that they 
cannot keep up in the regular grades. Pupils are admitted to these classes by 
recommendations from the Vocation Bureau which in selecting this group 
aims to: 

"(1) Eliminate mental defectives. 

(2) Select retarded children of approximately normal ability who 
can make up part or all of their retardation and be returned to the grades. 

(3) Select retarded children of inferior ability who can do better 
work in a small group and with the more varied curriculum."* 

83 

These classes are conducted in seven different schools and they had a total 
average attendance in November of 555 pupils from all over the city. These 
classes are conducted somewhat differently in the different schools. However, 
the center of this work is at the Dyer School, and the classes there are typical 
in general of the others. At the Dyer Opportunity School, the average attend- 
ance during November of this year was 180 pupils, with from 25 to 30 pupils 
to a teacher, and one supervisor. About three hours of the school day is 
devoted to academic work and two hours to artistic and manual work. The 
opportunities for manual work include wood work, metal work, tire vulcan- 
izing, pipe outfitting, electrical work, shoe soling and printing. The industrial 
work for the girls includes sewing, cooking and weaving. 

(4) The Pre-vocational or industrial classes in the elementary schools 
were established to take care of the pupils who did not intend to remain in 
school any longer than the time required by law. It was learned by exper- 
ience that this group comprised almost all of the badly retarded children in 
the school who were making a complete failure in the last two grades. It was 
believed that a course with greater stress on manual work should be devised 
for them, so that they would leave school with some industrial efficiency. It 
was also found that this group of children could do much better work along 
manual lines and that they were thus taken away from the atmosphere 
of failure which was the worst possible influence for them. Very often the 
children who have completed the work in the opportunity classes are passed 
on to these industrial courses. 

Five different schools now have these industrial classes, and each is run 
as the needs of that particular school population demand. In most cases they 
are classes for the retarded children who indicate their desire to take the 
course instead of the regular grade of work of the fifth, sixth and seventh 
grades. However, one school takes children from the third grade and another 
takes them through the ninth grade and offers courses that are practically 
Smith Hughes Vocational classes. It is not required that these pupils be 
examined by the Vocation Bureau before they are admitted to the pre-voca- 
tional courses. The average attendance in November in all of these classes was 
about 857. The course of study in most of them is two-thirds academic and 
one-third vocational work. The vocational courses offered are preliminary 
work in wood and metal work, printing, sewing, cooking, typewriting, 
and stenography. In some of the schools, in the higher grades, only half-time 
is given to academic work, the rest being occupied with vocational work. 

*Mrs. Woolley's Syllabus for Teachers Class No. VII, "Mental Tests as an Aid in Giving 
Educational Advice/' page two. 



MENTAL HYGIENE SURVEY OF CINCINNATI 85 

(5) There are three different schools for delinquents in the public school 
system: the Boy's Special School and the schools at the Boy's Opportunity and 
Girl's Opportunity Farms. The Boy's Special School is made up of truants and 
delinquents committed by the Attendance Department of the Public Schools 
and by the Juvenile Court. Every boy is also examined at the Vocation 
Bureau. The average attendance in November was 52. The total number of 
regular teachers is three and in addition to this there is a manual training 
teacher half of every day and an art teacher once a week, making the number 
of pupils per teacher about 17. No special training, other than that required 
of every school teacher, is required of the teachers, and they are on regular 
public school salaries. The principal of the school is on a regular principal's 
salary. Nearly one-half of the day is given over to manual and art work, the 
other half being devoted to academic courses. The grades in the school run 
from one through eight. The manual-training room is well equipped for all 
kinds of wood work. The school is much handicapped by not having a 
gymnasium, because physical training ought to be a part of every school course 
and is especially important with boys of this character. Another disadvantage 
of this school is that there is no provision for serving the pupils a hot lunch 
at noon, even though they come from all over the city, making it impossible for 
many of them to return home for the noon meal. 

The Board of Education also conducts the schools at the Girls' and Boys' 
Opportunity farms. The average attendance for November at the Girls' Oppor- 
tunity Farm was 56, at the Boys' Farm it was 71. The Girl's school has two 
teachers, making an average of 28 pupils per teacher, while the Boys' School 
has three teachers, making an average of 27 pupils per teacher. The teachers 
in these classes are on regular public school salaries. The course of study in 
these schools is much the same as in the regular grade schools, the greatest 
stress being put on the academic work, though some time is given to teaching 
sewing, stenography, and typewriting to the girls and manual training to the 
boys. 

(6) The classes for the blind are of two different kinds: 

(1) The conservation of vision classes. 

(2) The blind classes. 

Before children are accepted in the school, they must be examined by the 
school oculist and a report filed in the supervisor's office as to their vision 
defect. Those who are found to have between one-third and one-tenth vision, 
even when corrected as far as possible with glasses, are placed in the conserv- 
ation of vision classes, while those with one-tenth vision or less are put in the 
blind classes. The average enrollment for November was 64, with 16 in the 
blind department and 48 in the conservation of vision classes. There are 
seven regular teachers, one supervisor, and one visiting teacher, the latter 
being free from class room work and able, therefore, to do a good deal of 
home visiting to educate the families as to how best to save the vision that the 
children have. The number of pupils to a teacher is about seven. The salaries 
of the teachers are $150 more per year than those of the regular teachers. The 
supervisor is on a regular principal's salary. Although no special training is 
required of the teachers, they are given lectures during the year on conserva- 
tion of vision. The state pays all the additional expenses for these classes over 
the regular per capita cost to the Board of Education for every school child. 

The basic principle of the work is to have the children participate as far 
as possible with the normal children. For this reason the blind classes are in 
the regular school buildings, and the pupils have as many of their recitations as 
possible with the regular grades. Every effort is made to get the blind chil- 
dren away from the artificial standards which the teacher unconsciously 
makes for pupils so handicapped, and they are trained to take their places 
in the world alongside of seeing people. The course of study is much the 
same as that in the regular school system except that special attention is given 
to sense training and hand work and every effort is made to broaden the 
child's experience, a thing very necessary with a blind child because he cannot 



86 MENTAL HYGIENE SURVEY OF CINCINNATI 

gain his experience in the ordinary course of the day's work as the seeing 
child does. The classes are fully equipped with typewriters, Braille writing 
appliances, Braille books, educational models, charts, special maps and globes. 

The conservation of vision classes have as their aim the attempt to con- 
serve all the vision that the child has. To this end the very best and most 
modern system of lighting, to prevent shadows and a glare, is used, together 
with Molthrop desks, large-print books, special illustrative pictures with a few 
lines, and paper with no glaze, and the children are taught an especially round 
handwriting because it is easier on the eyes. The pupils in these classes 
always recite with the regular grades. The function of the teacher is to be 
the eyes for the child. If there is no large-print text book for the child to use 
in connection with the lesson assigned, then the teacher reads the lesson to 
him. 

The children in both of these groups of classes have special corrective 
exercises for posture, as eye defects often cause very bad positions. 

The state law which provides for the establishment of these classes has 
elaborate requirements as to the size of the class rooms, the equipment desired, 
the number of pupils to a teacher, the kind of lighting, the color of the walls 
of the school room and the amount of extra blackboard area, these latter 
requirements being, of course, for the conservation of vision classes. 

(7) The oral classes are of three different types: 

(1) Classes for the totally deaf, who are taught through the eye and 
feeling sense. 

(2) Classes for the semi-deaf, who are taught through hearing 
sometimes by the aid of ear phones. 

(3) Corrective speech classes for hearing children in the schools. 

The classes for the totally deaf and semi-deaf are all in one regular grade 
school building. The number of pupils in these two groups is 55. There are 
eight teachers and one supervisor, making an average of seven pupils to a 
teacher. All the teachers are unusually efficient as they are required to have 
special training for work with the deaf, either at the State Training School 
for the Deaf or in some other training school, and they receive $150 more per 
year than the regular school teacher. The supervisor is on a regular princi- 
pal's salary. This department, as well as the blind department, receives a 
state subsidy. 

The course of study in the first and second grades of the school has 
speech language as its major subject. After that, however, the aim is to 
pursue the regular school course, and the children are taken through the eight 
regular grades. The children of the older grades have manual training, 
domestic science, art, and writing with the regular public school classes, the 
idea being that they gain a great deal by association with normal children 
whenever this is possible. 

In addition to this work at the Oral School, there is a visiting teacher who 
works with corrective speech in the regular schools. This teacher rotates from 
school to school staying ten weeks in each school; she takes six pupils 
at a time for one-half hour periods and helps them to correct their speech 
defects. Cases of bad speech defect are reported by the principal of the 
school to this visiting teacher. 

(8) There are five different schools that have open-air classes for the 
underweight and anemic children who are accepted in a class only after a com- 
plete physical examination by the school physician. The average attendance 
in November in these classes was 102. These classes are given from the first 
to the seventh grades. The five teachers who conduct these classes are on 
regular school salaries. The average number of pupils to a teacher is about 20. 

Only about three hours of the school day is given over to academic work, 
the rest of the time being spent on health measures. Every effort is made to 
build up the children physically. They are fed milk at nine in the morning and 
at three in the afternoon and given a hot lunch at noon. Each child has its 



MENTAL HYGIENE SURVEY OF CINCINNATI 87 

temperature and pulse taken every morning. A shower bath each morning and 
a complete rest for one hour every afternoon also form part of the day's pro- 
gram. The children are all equipped with coats, hoods, gloves and warm boots 
and each child also has a cot and a sleeping bag for his or her afternoon rest. 
Every child sees the school doctor twice a week, and at such times is weighed 
and looked over by him. 

Two fresh-air classes for pre-tuberculous children are also conducted at 
the Branch Hospital. The average attendance in November was 92. 

The following figures show how successful these classes have been in the 
last year. 

TABLE 41— FRESH AIR SCHOOLS* 

Average 

Gain per Greatest Lost 

Puoil Gain for Gained more than Weight 

Number per Term Term 5 Pounds During 

in Class Pounds Pounds Boys Girls Term 

Tuberculosis Sanitorium 54 4.912 23^4 10 10 7 

Dyer School 26 4.778 12 7 4 1 

Sands School 27 6.175 13 7 111 

Guilford School 29 6.31 12% 5 11 

Douglass School 21 4.226 12^4 4 3 1 

Rothenberg School ... 25 4.1 8 8 5 1 

(9) The public schools also conduct, with the aid of a state subsidy, 
a school for crippled children at the General Hospital. The classes for these 
cripples are of two different kinds, as there is an effort made to teach the 
eonvalescent children on the wards as well as to conduct a school for crip- 
pled children out in the community. The number of these convalescents, in 
November, who were taught by the one visiting teacher was 78. The num- 
ber of crippled children who came into the school from outside was 83, 
for which there were four teachers, including the principal. These teachers 
receive S150 more per year than the regular school teachers' salary. The 
children are conveyed to the school in busses. Beside the regular school 
course, these children have such industrial work as is suited to their limited 
capacities. Basket weaving and reed work are taught, as well as sewing. 
A great deal of emphasis in this school is laid on the building up of these 
children physically and a remarkable amount has been done by modern 
plastic surgery toward correcting their physical infirmities. 

(10) There is only one class exclusively for foreigners in the city. 
This had an average attendance in November of 24 pupils, with one teacher. 
Some of the schools have made special provision for teaching the foreigners 
in their own district along with their regular classes, but this class is the 
only one that takes foreigners from all over the city, and has, as its one subject 
for study, the English language. As soon as the children can speak enough 
English to get along in the regular grades, they are passed on to them. 
The course of study includes grammar, reading, writing, and story telling 
in all of its forms. 

SUGGESTIONS 

Any suggestions as to the improvement of the special classes would, 
in order to be carried out, necessitate an increased expenditure, which is 
unfortunate because, due to the failure of the additional school levy to 
pass, the school board is forced to cut down expenses this year in almost 
every department. 

Conditions call for a much larger special school for defectives, as there 
is at present a large waiting list made up of pupils who have been recom- 
mended for this work by the Vocation Bureau. Our present survey shows 
that there are between 800 and 900 mentally defective children in the public 
schools. Provision should be made for classes in the outlying districts to do 

*Cincinnati Sanitary Bulletin, November 10, 1921. 



88 MENTAL HYGIENE SURVEY OF CINCINNATI 

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MENTAL HYGIENE SURVEY OF CINCINNATI 



away with the long car ride that many of the pupils must take at present. 
Equipment for industrial training, besides the training in wood work now 
provided, would increase the value of the school a great deal. The salaries 
of the teachers should be larger than those of the regular school teachers, 
as special training for work with the feebleminded ought to be required 
of every teacher doing this sort of work. 

An even more serious need of the special class system is, however, a 
larger and better Boys' Special School. This school, at present, seems 
to be merely a place to segregate the bad boys, and is not nearly as well 
equipped as the regular grade school. 

Unless these two schools are large enough, there is a tendency, even 
though guarded against by the Vocation Bureau, to push the feebleminded 
and problem cases into the observation, opportunity, and pre-vocational 
classes, thus destroying the full value of these types of classes. 

The observation, opportunity, and pre-vocation classes have proved 
themselves to be of great value in dealing with the retarded child who is 
not mentally defective, and they should be so increased and enlarged as to 
take care of all such misfits in the school population. There should be 
supervisors over each of these types of classes. Admittance to the pre-vo- 
cational classes should be subject to the approval of the Vocation Bureau 
in the same manner in which this is required with the observation and 
opportunity classes. 

DISCUSSION OF PUBLIC SCHOOL FINDINGS 

Approximately 12 per cent of the public school children in this survey 
were classified as either subnormal in intelligence, mentally defective, "nerv- 
ous" or psychopathic, or suffering from epilepsy or endocrine conditions. 

It will be remembered that we found 6.2 per cent of the public school 
children showing conduct disorders. A great majority of these behavior 
cases were found amongst those mentally handicapped. 

These children are not only difficult problems for the school authorities 
today, but, if not properly diagnosed, given suitable medical and psychiatric 
treatment, educational training, and, in the case of those needing such care, 
kindly and friendly oversight and supervision, the great majority are destined 
later on in life to social failure and mental breakdowns, thus providing 
our public authorities and private agencies with their unimprovable cases of 
dependency, delinquency, and insanity, conditions that are already costing this 
community millions of dollars. 

It cannot be stressed too strongly that the measure of our intelligence in 
preventing crime (a condition that, it is estimated, is costing this country 
more than two and a half million dollars a day to handle), insanity (which 
is requiring more hospital beds than all other medical conditions), depend- 
ency (a condition that from generation to generation, through our expendi- 
ture of millions in relief, has provided socially minded persons with an 
outlet for their charitable impulses), is the degree of thoroughness with 
which we organize machinery in connection with our public schools for 
recognizing and adjusting those individuals who, because of their mental, 
physical, and social handicaps, are the potential criminals, insane, and depend- 
ents of the future. 

Our survey has shown that the public schools of Cincinnati are par- 
ticularly well equipped to deal with the problem school children whose 
short-comings are largely within the field of general intelligence, learning 
capacity, vocational aptitudes, etc. However, the psychopathic children and 
the children that show conduct disorders, which form such a large per- 
centage of the problems of the public schools of this city, are not effectively 
dealt with. The conditions from which they suffer are not adequately 
recognized and given that medical and social treatment which full under- 
standing and appreciation would demand. 



90 



MENTAL HYGIENE SURVEY OF CINCINNATI 



This is a matter of the most serious import if we are going to dam the 
stream at its source. 

The most fundamental need that this survey of the public school children 
has pointed out is for a central psychiatric clinic to which may be sent 
those problem school children who require the most intensive and well- 
rounded study, medical, psychiatric, and social treatment, and adjustment. 

We cannot close without some reference to the so-called "normal" child 
whom we must not forget in our efforts to aid the abnormal. The mental 
diagnosis table shows that 3,003 out of the 4,326 studied were "normal." 
This must not be construed to mean that they were at all similar. Closer 
analysis shows that only 880 of them were at age; 707 of them repeated 
grades; 245 were irregular in their attendance at school; 253 were rated by 
the teachers as doing "poor" school work; 192 of them were in very poor 
health and needed medical attention; 98 had shown serious behavior condi- 
tions and disorders of conduct; 580 showed some character defects and 
personality difficulties. We find among them almost every possible diverg- 
ence, though perhaps on a less glaring scale than in the case of those who 
were considered mentally handicapped. 

We could commit no more serious error than to classify these children 
as "normal" and then cease to bother about giving them individaul training. 
That these "normal" children do get into trouble and provide society with 
many social problems is shown by this report, and yet it is from them that 
all of the promise of the future is to be expected. Real mental hygiene 
work will find amongst this group an incalculable return on any investment 

CLINICAL FACILITIES FOR EXAMINATION OF MENTAL 
CASES IN CINCINNATI 

The following are the agencies which offer clinical facilities for some type 
of mental examination in Cincinnati. 

Source of Finance Type of Service Rendered 

Cincinnati Board of Edu- a. Supervision of Child 
cation and Community Labor; Attendance and 
Chest. Census. 

i; ;, I 2 h. Psychological examin- 

ations for Social Agen- 
cies, Public Schools 
and Juvenile Court. 

2. Neurological Clinic of Medical School, Univer- Offers mental examin- 
Out- Patient Dispens- sity of Cincinnati; Psy- ation to Social Agencies; 
ary, Medical College, chiatric Social Service Supervises parole patients 
University of Cincin- furnished by the Associ- from Longview Hospital 
nati. ated Charities. for Insane. 



1. Vocation Bureau. 



3. Psychopathic Institute 
of the United Jewish 
Social Agencies. 

4. N e u r o - Psychiatric 
Clinic of the Medical 
Department, United 
Jewish Social Agen- 
cies. 



Community Chest. Cases referred for obser- 

vation and mental diag- 
noses from Social Agen- 
cies and private sources. 

United Jewish Social Mental examination of 
Agencies (Community cases referred from the 
Chest.) General Medical Dispens- 

ary of the United Jewish 
Social Agencies. 



The above agencies are the chief facilities offered by Cincinnati for the 
free examination of mental cases at the present time. 



MENTAL HYGIENE SURVEY OF CINCINNATI 91 

I. VOCATION BUREAU 

HISTORY 

The first step toward the organization of the Bureau were taken in 
1910, but the organization was not completed until 1911. The project was 
conceived and planned by Miss Edith Campbell, of the Schmidlapp Foun- 
dation, Mr. E. N. Clopper, of the National Child Labor Committee and 
Mrs. Helen T. Wooley. The original plan was to make a thorough study of 
child labor in Cincinnati. In order to obtain control of the means of investi- 
gation, the Bureau took over the School Office which issued employment cer- 
tificates. In order to have facilities for making mental and physical tests 
of children the Bureau established a psychological laboratory and department 
of home visiting and made some provision for investigation of places of 
employment. 

From 1911 until 1915 the activities of the Bureau were confined to the 
administration of the Employment Certificate Office and the investigation 
of a group of working children, which included mental and physical tests, 
home visiting and industrial investigations. A very careful mental and physical 
study of the working child was made, which included comparison with the 
children who remained in school. 

In 1915 the Placement Office was added. This office attempts to apply 
the information acquired about the individual child, in adjusting him to 
industry and in aiding him in his choice of a job. 

In 1916 the Psychological Laboratory of the Vocation Bureau took over 
the task of selecting children from the school system, for assignment to 
classes for defectives.' The Laboratory has since developed into a psy- 
chological clinic for the schools and social agencies. 

In 1918 the Bureau took over the Scholarship Committee whose purpose 
was to keep in school bright and promising children who otherwise would 
be forced into industry too early. 

In 1919 the supervision of the psychological testing in the Juvenile Court 
was assigned to the Bureau. Two members of the Clinical Staff of the Voca- 
tion Bureau are assigned to duty in the Juvenile Court. 

In 1920 the co-operation of the Court and the Schools was made still closer 
by the appointing as a member of the staff of the Vocation Bureau an "ad- 
justment officer," whose task it is to take over delinquents of school age 
guilty of minor delinquencies — and attempt to deal with them as school cases 
only, thus saving them a Juvenile Court experience and record. 

During the same year a department of educational tests and measure- 
ments was created — the purpose of which was — by means of group tests to 
measure the success of teaching of various subjects. 

At about the same time a volunteer committee for the supervision of 
feebleminded in industry was organized. 

Finally in 1920 the Attendance Department of the School was consolidated 
with the school and made one of its departments. 

Organization. At present the Bureau is organized into four departments, 
each with an assistant director in charge, who is responsible to the director 
of the Vocation Bureau. These departments are: 

1. School Attendance and School Census, with an assistant director 
in charge, and a staff consisting of one court officer, six field 
officers and one stenographer. 

2. Child Labor and Placement, with assistant director in charge, 
and four assistants, one stenographer and one clerical worker. 

3. Psychological Laboratory, with an assistant director in charge, 
seven laboratory assistants and examiner, two stenographers and 
one social investigator. 



Chest Education 

$20,000 



$19,880 



92 MENTAL HYGIENE SURVEY OF CINCINNATI 

4. Research and information with director of Vocation Bureau in 
charge, covers: 

Civic and vocational information, 

Five-year study comparing working and school children. 
Study of observation classes. 

SOURCE OF FINANCES 

The Vocation Bureau is jointly financed by the Community Chest and the 
Board of Education. 

The budget of the Bureau is divided as follows: 

Staff Community Board of 

Director of Bureau " 

Assistant Director in charge Psychological Clinic 

Seven Laboratory Assistants and Examiner 

One Clerical worker 

$6,000 for scholarships 

Assistant Director in charge Child Labor and 

Placement 

Four Assistants 

Three Stenographers 

Five Psychological Laboratory Assistants 

One Home Investigator 

Supplies and equipment 2,500 

One Assistant Director in Charge Attendance 

Department 

One Court Officer I <tir; onn 

Five Field Officers f »KMWJ 

One Stenographer j 

Temporary employees for School Census J 

Supplies and equipment 1,750 

DEPARTMENTS— PLACEMENT AND CERTIFICATE OFFICE 

The Employment Certificate Office has the responsibilty of carrying out 
provisions of the Child Labor Law of the State of Ohio, with regard to all chil- 
dren working in the Cincinnati school district. The law provides at what year 
a boy or girl may be employed, forbids certain injurious occupations and pro- 
vides that the child must be in a satisfactory state of health. To make sure that 
each child complies with these conditions, each applicant must have four 
credentials — a legal birth record, a certificate showing school record, employer's 
card giving the name of the employer and kind of employment and a health card 
signed by a physician of the Board of Health. Boys and girls who have not 
completed a required grade are considered individually to determine whether 
or not a work certificate should be issued, on the ground that the child is 
too inferior mentally to complete the required academic work. These children 
are tested in the Psychological Laboratory if necessary. 

In addition to these legal duties, the Certificate Office helps children to 
have physical defects corrected to enable them to obtain certificates, endeavors 
to persuade children to return to school or to continue their education at 
night school, and refers children of superior intelligence to the Scholarship 
Committee. Upon the termination of the employment of the child, the cer- 
tificate must be returned to the issuing office. The child, when he takes 
another position, must return to the issuing office to have the certificate 
renewed. 

The Placement Office has the function of helping any young person of 
legal working age who is leaving school to secure employment suited to his 
training and capacity. This office supervises the work of these children in 
industry; keeps in touch with employers and keeps a full record of the child's 



MENTAL HYGIENE SURVEY OF CINCINNATI 93 

industrial success or failure. It also makes studies of occupations and consults 
with employers about their needs for young workers. 

SUPERVISION OF THE FEEBLEMINDED IN INDUSTRY 

For applicants who are classified as mentally deficient, the Placement Office 
calls in the services of the Committee on the Supervision of the Feebleminded 
in Industry. This committee supervises all children between the ages of 16 and 
18 years, going through the Placement Office for jobs, who are known to be 
feebleminded. This supervision is carried out through the United Jewish Social 
Agencies, the Bureau of Catholic Charities and the Associated Charities, the 
three principal case-working Social Agencies in Cincinnati. The purpose of 
this supervision are two-fold: 

1. Research regarding the feebleminded in industry. 

2. Social supervision of the feebleminded. 

The social agency to whom the case is referred gathers additional infor- 
mation regarding the child, information about the family heredity, and general 
attempts to adjust the family situation. The Vocation Bureau makes the con- 
tact with the employers of these feebleminded individuals and secures other 
jobs. The agency supervising the case makes monthly reports to the Vocation 
Bureau. At present there are 150 feebleminded individuals under supervision 
distributed as follows: 

Girls 50 

Boys 100 

PSYCHOLOGICAL LABORATORY 

The Psychological Laboratory endeavors to serve the needs of the 
schools, the Juvenile Court and Social Agencies of the city by giving individual 
psychological examinations to referred cases. The work of the laboratory 
for the year from August 31, 1920, to September 1, 1921, is represented by 
the following table: 

Total group examinations 12,882 

Total individual examinations 2,510 

SOURCE OF CASES 
These cases were referred as follows: 

Referring Agency Number 

Attendance Department 25 

Placement Office 83 

Employment Certificate Office 128 

Juvenile Court 405 

Social Hygiene Society 5 

Oh.io Humane Society 15 

Associated Charities 15 

United Jewish Social Agencies 6 

Bureau of Catholic Charities 1 

Children's Home 11 

Hospital and Out-Patient Dispensary 18 

County Board of Health 2 

Unclassified Social Agencies 20 

Miscellaneous 37 

TOTAL (Referred by Social Agencies) 771 

TOTAL, Referred by Schools 1,739 

GRAND TOTAL .2^510 



94 MENTAL HYGIENE SURVEY OF CINCINNATI 

CLASSIFICATION OF CASES 
These cases were classified as follows: 

Classification Number Per Cent 

Feebleminded 478 19 

Borderline ' 457 18 

Dull Normal 590 23 

Average 584 23 

Superior 334 13 

Unclassified 87 3 

DISPOSITION OF CASES 

The laboratory gives advice to the agency or school, referring the case, 
based on the results of the psychological examination. The laboratory is 
handicapped by the lack of facilities in the way of special classes in the 
schools. This means that many of the recommendations are not carried 
out, or are carried out after so much delay that the usefulness of the 
service is actually lessened. There is always a long waiting list for the special 
classes. The outlying schools have no special classes and transportation to 
Special No. 3 (for clearly feebleminded children) is extremely difficult. There 
is urgent need for more outlying classes and for more provision centrally. 

From September 1, 1920, to August 31, 1921, the following recommenda- 
tions were made by the laboratory: 

No. Recommended Recommended to 

242 Special No. 3 (for Mental Defectives). 

60 Observation Classes (Problem cases). 

108 Opportunity Classes (Dull and over-age). 

26 Exclusion from school. 

TYPE OF EXAMINATION 

All of the standard psychological tests are given by the Psychological 
Laboratory, including the Stanford Revision of Binet-Simon, various per- 
formance tests, educational tests, any special tests where indicated. Accom- 
panying the child through the Bureau when he is examined is his cumulative 
record from the school. This record is a complete summary of his school 
history. 

MEDICAL EXAMINATIONS 

All children referred from schools come under the provision for 
medical examinations in the schools. The results of such examinations 
are supposed to be entered upon the cumulative records and therefore avail- 
able for use at the Psychological Laboratory when the children come for 
examination. However, in many cases no examination has been made, or 
the results have not been entered upon the card. When made, the indi- 
cations are that it is frequently rapid and cursory. When recommendations 
are made by the laboratory that medical examinations be given, it is possible 
to follow out the recommendation only in a small portion of the cases. 
Where cases stand in especially urgent need of medical attention they are 
sent to some suitable clinic and the home investigator makes a home visit to 
arrange for clinical attention. 

PSYCHIATRIC SERVICE 

Various psychiatrists have volunteered their service to the Bureau for 
examination of especially referred cases. The following indicates the extent 
of his service in the year, August 31, 1920, to September 1, 1921. 

Number given Psychiatric Examination 348 

Per Cent 14 

The Psychological Laboratory of the Vocation Bureau recognizes that this 
is a very unsatisfactory situation, and attempts have been made to have regular 



MENTAL HYGIENE SURVEY OF CINCINNATI 95 

medical service and special psychiatric service provided for in the budget of 
the Bureau. Up to this point, however, it has not been possible to secure 
provision for such services. 

JUVENILE COURT 

The Psychological Laboratory of the Vocation Bureau furnishes the 
full time services of two psychologists to the Juvenile Court. These two 
individuals are part of the examining staff of the Psychological Laboratory. 
The court furnishes them office space and they examine problem cases 
referred by the probation staff and the judge. 

HOME VISITING 

Attached to the staff of the laboratory is one person to whom is assigned 
the duty of making home investigations. Her duties are briefly as follows: 

1. Arrangements for transfer from regular schools to Special No. 3 
(for the mentally deficient), Opportunity or Observation Classes; 
visits families to explain to them the reason and necessity for the 
transfers to these special classes. 

2. Visits parents to talk over the possibility of sending their children 
to State Institutions for the Feebleminded and Epileptic, where 
such recommendations have been made by the psychological La- 
boratory. Accompanies parents to Probate Court and to the train 
when child leaves. 

3. Investigates home conditions where requested by the examining 
staff to gather further data regarding the heredity, environmental 
situation as an aid to diagnoses. If necessary cases are referred to 
Associated Charities and Ohio Humane Society or other special 
agencies. 

4. Persuades parents to take children to clinics for necessary treat- 
ment. 

The following total represents the work of the home visitor for the period 
from January 1, 1921, to August 31, 1921: 

Visits for Investigation 141 

Visits for Service or Supervision 321 

Total 462 

EDUCATIONAL MEASUREMENTS 

In addition to the group mental tests that are used in working out educa- 
tional classifications, educational tests in writing, spelling, arithmetic and 
other school subjects are given. These tests measure the success of the 
educational work. 

SCHOLARSHIPS 

The purpose of the scholarship is to assist capable high school students 
in completing their high school course. In order to be eligible for one of 
the scholarships, the child must be of legal working age. A visit is made to 
the child's home to determine financial ability. In addition a psychological 
test is given in the Psychological Laboratory to determine whether or not 
the child is mentally able to benefit from high school training. The case is 
then presented to the Scholarship Committee which consists of members of 
the staff of the Vocation Bureau, student consulars in the high school and 
interested individuals. The scholarships vary from $25.00 to $250.00 a year, 
according to the need of the student. At the present time there are 41 
active scholarships amounting to a total of $776.00 per month. 

SCHOOL ATTENDANCE AND CENSUS 
The taking of the school census is part of the duty of the assistant 
director in charge of the Attendance Office. The returns are used to dis- 



96 MENTAL HYGIENE SURVEY OF CINCINNATI 

cover children illegally out of school; to discover handicapped children who 
need special provision; to check child labor and to serve as a permanent card 
index to all school children. 

The Attendance Department enforces the school attendance law. The 
attendance officers are trained for their work by a series of Saturday con- 
ferences in which all of the organizations which might help in solving dif- 
ficult problems of children are invited to come and explain the kind of work 
done and the type of case which should be referred to the organization. 

SUMMARY 

The Vocation Bureau is of major importance and its achievements are 
outstanding in the field of mental hygiene in Cincinnati. The supervision 
of the feebleminded in industry, the home invesigations, the general super- 
vision of the working child are worthy of special note. The activities that 
have to do with placing children in industry, school attendance, delinquency 
and the supervision of the feebleminded are closely related activities, but the 
Vocation Bureau in Cincinnati is unique in that they are under the same 
organization. , 

The psychological examinations would be more effective if they included 
psychiatric as well as psychological procedures. The Vocation Bureau recog- 
nizes the importance of this and has made frequent efforts to increase their 
psychiatric service. Many children, particularly the marked behavior cases, 
can only be properly understood and adequately dealt with after a well- 
rounded and careful medical examination has been made. This can best be 
secured at a Central Psychiatric Clinic when a period of observation may 
likewise be available. 

A larger staff to handle the supervision of the feebleminded in industry 
would seem advisable. An enlarged staff would make it possible for a very 
much larger number of children who are mentally deficient to be placed under 
supervision in the community, than at present. 

This supervision should be more closely connected with the work of the 
present social investigator, i. e., the social investigations which are now con- 
ducted for aiding in diagnosis would become a part of the general work of 
supervision of the feebleminded. 

II. THE PSYCHOPATHIC INSTITUTE OF THE UNITED JEWISH 

SOCIAL AGENCIES 
HISTORY 

The Phychopathic Institute was opened July 27, 1920. An old residence 
located near the present Jewish Hospital was taken over. This building which 
consists of two floors and about 8 rooms, was entirely renovated and 
remodeled. The capacity is 12 beds (eight free beds and four pay beds). 

ORGANIZATION 

The staff of the institute is made up of a paid and volunteer personnel. 
The paid personnel consists of a matron and a maid. 
The volunteer group is made up of: 

1. The medical group which includes a director, attending house 
physician, and the entire staff of the Jewish Hospital as con- 
sultants. 

2. The social group which consists of a psychiatric social worker in 
charge, with a corps of assistants. In addition a teacher from the 
public school is assigned for intensive academic work. There is 
also a teacher in vocational training to bring out special aptitudes. 

SOURCE OF FINANCES 

The budget for the past year was $7,200.00 furnished by the Community 
Chest. This budget is supplemented by the United Jewish Social Agencies. 



MENTAL HYGIENE SURVEY OF CINCINNATI 97 

PLAN AND SCOPE OF WORK 

The Psychopathic Institute exists for the observation and diagnoses of 
maladjusted psychopathic and subnormal children. It is not a treatment 
agency, but during the period of observation it is the purpose of the staff 
to give very intensive study of each case in an environment which is as 
normal and home-like as possible. 

NUMBER AND SOURCE OF CASES 

Since the establishment of the Psychopathic Institute in July, 1920, 51 
cases have been admitted, referred as follows: 

Source Number 

Privately referred 11 

Pediatrics Department C. G. H 2 

Bureau of Catholic Charities 1 

Hamilton County Red Cross 1 

Juvenile Court 3 

Ohio Humane Society 2 

United Jewish Social Agencies 31 

TOTAL 51 

CLASSIFICATION OF CASES 
The above cases were classified as follows: 

Classification Number 

Environmental 23 

Endocrine 5 

Organic 13 

Feebleminded 7 

Undetermined 3 

TOTAL 51 

The discharged cases were distributed as follows: 

Cured 10 

Improved 10 

Unimproved 19 

TOTAL DISCHARGED 39 

TYPE OF EXAMINATIONS 

Every case before admittance into the Psychopathic Institute spends 24 
hours in the Jewish Hospital, at which time a complete physical examination 
is made, including blood count, Wasserman, lumbar-puncture (where in- 
dicated), urinalysis, X-ray of skull and teeth and other X-rays as indicated. 
At the institute the examinations are further continued, including eye, teeth, 
psychological tests, and other specialized tests as indicated. Special effort 
is made to bring out vocational aptitudes and stimulate special interest on 
the part of the children. In this connection two afternoons a week are 
spent at toy making, one afternoon at basketry and Saturday afternoon is given 
up entirely to recreation. The children attend public school. 

SUMMARY 

The work of the Psychopathic Institute is of a very careful and intensive 
type and is of the highest order. But a small number of cases are handled 
and the most intensive study is given them. The institute exists merely for 
diagnosis and observation, and has done much to demonstrate the import- 
ance of environment, special training and individual study in the treatment 
of problem children. We believe the institute may best serve as a research 



98 MENTAL HYGIENE SURVEY OF CINCINNATI 

center in developing methods for the study and treatment of the unadjusted 
and maladjusted child. 

It would seem that too small a number of cases have been handled to 
make it of large service to the city. The total capacity of the institute 
is but twelve beds, which greatly lessens its ability to serve in the social 
problems of Cincinnati. 

III. NEURO-PSYCHIATRIC CLINIC AT THE UNITED JEWISH 

SOCIAL AGENCIES 

This clinic is a part of the General Medical Dispensary at the United 
Jewish Social Agencies; it meets two hours a week and examines cases re- 
ferred by the General Medical Staff at this dispensary. This clinic assists 
the Case Department of the United Jewish Social Agencies in trying to 
solve family difficulties, social maladjustments, failure to provide, desertion 
and other home difficulties. Many of the cases examined at this clinic are 
referred to the Psychopathic Institute. 

IV. NEUROLOGICAL CLINIC OF THE OUT-PATIENT DISPEN- 

SARY UNIVERSITY OF CINCINNATI, COLLEGE 
OF MEDICINE 

ORGANIZATION 

This clinic meets Wednesday and Friday from 4:00 to 5:00, at the Out- 
patient Dispensary of the Cincinnati General Hospital. The staff consists 
of four psychiatrists and a psychiatric social worker. 

PLAN AND SCOPE OF WORK 

This clinic is a free clinic, examining all types of mental cases referred 
by agencies, private individuals, and other clinics in the Out-patient Dispen- 
sary. 

The Associated Charities furnishes the services of a trained psychiatric 
worker who attends all sessions of this clinic. 

The clinic serves as the out-patient department of the Longview Hospital 
for the Insane. The superintendent of this hospital is a member of the staff 
of this clinic, and sees paroled patients from Longview during clinic hours. 
The majority of these paroled patients are not handled as clinic cases. The 
Associated Charities exercises supervision of these paroled patients through 
the psychiatric social worker, who is its representative at this clinic. 

Three hundred and fifty-eight cases attended the clinic from January 1, 
1921, to January 1, 1922. 

These cases were referred as follows: 

Personal application 184 

General Hospital 79 

Associated Charities 42 

Private physicians 20 

Department of Public Welfare 3 

American Red Cross 1 

Juvenile Court 4 

Vocation Bureau 5 

Other clinics 11 

Ohio Humane Society 1 

Other sources 8 

TOTAL 358 

CONCLUSIONS 

When it is seen that 3.5 per cent of all the public school children studied 
were found to be cases of psychopathic personality, and that fully 6 per cent 
showed conduct disorders, it can be appreciated how large is the psychiatric 



MENTAL HYGIENE SURVEY OF CINCINNATI 99 

phase of public school work. If we now carefully go over the clinical facil- 
ities of this city and note the total number of problem individuals that are 
receiving well-rounded, thoroughgoing medical, psychiatric, psychological, 
and social diagnosis, we must be impressed with the fact that even the most 
urgent needs of the city school children are not being met. One phase of the 
cost of this may be seen in the expense of the particular group of repeaters 
among the 4,326 children studied. It will be remembered that 1,685 children 
repeated 2,250 grades at a cost of approximately $143,000. 

The study of juvenile delinquents in the Juvenile Court showed that the 
large majority had Intelligence Quotients above 80, and that the question of 
general intelligence was by no means the important causative factor in the 
delinquent conduct of these children. It was pointed out that serious mental 
conflicts and mental maladjustments, many and varied physical disorders, 
and bad home influences, were the outstanding factors underlying the conduct 
of these children. These are largely psychiatric problems, and yet only 9 
per cent of the cases selected for psychological examination were referred 
to the psychiatrist. 

The immense problem in human salvage presented by the Municipal 
Court, with its 14,000 cases, (a large proportion of whom are repeated of- 
fenders) and the Hamilton County Jail (over half of whose inmates are 
repeated offenders) is being entirely neglected as far as the physical and 
mental conditions of these individuals are concerned. None of the clinics 
in the city are pretending to approach the problem even in the most elemen- 
tary way. The cost of crime is amazing to those who have the subject pre- 
sented to them for the first time. The average cost of convicting a person 
of a felony in the State of New York is $1,500. The results obtained from 
this expenditure, in the way of protecting society or of preventing a sub- 
sequent criminal career of the individual convicted, are in most cases almost 
negligible. On the other hand, the average cost of an initial medical, psy- 
chological, and social diagnosis of a delinquent individual is less than $50.00, 
and the result of such a diagnosis is often the effective management of 
delinquent trends that, unchecked, are bound to result in a further criminal 
career. It has been estimated that the cost of crime in the United States is 
not less than two and one-half million dollars a day. If there could be 
expended annually in Cincinnati for the study and treatment of offenders a 
sum equivalent to the cost of crime in this city for one week, results of far- 
reaching importance to humanity in general, and to Cincinnati in particular, 
would be obtained. 

Of the thousands of cases handled by the various social agencies of this 
city, only 877 received a mental examination during the last year and a half. 
And yet we believe, in the light of this study, that fully 75 per cent of all per- 
being dealt with as cases of dependency, illegitimacy, etc., by the social 
agencies of Cincinnati, show mental and physical conditions that are the 
most outstanding factors to be considered in connection with their relief. 

The clinical needs presented by the dependent and delinquent institu- 
tions, both juvenile and adult, are, as far as the mental condition of the in- 
mates is concerned, hardly being touched. 

It would seem that Cincinnati is making, in a small way, splendid efforts 
in various directions to meet the mental hygiene needs of the city. What 
does stand out, however, is the fact that in no place do we find that the work 
is either sufficiently comprehensive or adequately financed to be of the largest 
measure of service that the opportunities and needs offered would demand. 
It appears that in several places splendid clinical work is being done. But 
each piece of work is a unit unto itself, revolving on its own axis, absolutely 
independent of other activities. 

This is the weakness in the whole situation as we see it. There is an 
urgent need for a large central psychiatric clinic that will coordinate all 
work in this direction in the city; that will serve in an effective way the 
general community, the social agencies, the delinquent and dependent insti- 



100 MENTAL HYGIENE SURVEY OF CINCINNATI 

tutions, the juvenile and adult courts, and, finally, the public schools in helping 
them to deal with their problem cases. 

We believe that the main issues brought out in this report can be met 
only through the establishment of such a clinic. 

To this clinic would come voluntarily, from the homes of Cincinnati, 
early and mild mental cases for diagnosis, advice, and treatment; this at a 
period long before the individual could be considered commitable as insane, 
and at a time when he may possibly be restored to mental health. 

To this clinic would be brought problems of dependency, unemployment, 
illegitimacy, etc., from the various social agencies for careful study, advice and 
treatment. 

To this clinic should come serious behavior problems of the public schools. 
There should be a close relationship between the psychological department 
of the Vocation Bureau, and the proposed psychiatric clinic. The former should 
be used as an important outpost — a clearing house — through which all problem 
children in the public schools would pass. In this way there would be con- 
tinually sent back from the Vocation Bureau to the psychiatric clinic, for well- 
rounded study, observation, and treatment, all cases that could not be dealt 
with satisfactorily at the "front." It would seem desirable to have the psy- 
chologist of the Bureau a member of the staff of the clinic. 

From the clinic should go a "flying team" to serve the Municipal Court, 
the County Jail, and various dependent and delinquent institutions. 

It cannot be stressed to strongly that this clinic should not be merely a 
classification clinic — a place to give an individual a certain Latin designation 
and tag him with some sort of a diagnosis. It should be largely a treatment 
clinic, which, through its social service department, would work out in co-op- 
eration with the social workers connected with the various social agencies, 
with the probation officers in the courts, and with the supervisors of the 
problem school children, a well-planned program for the treatment and adjust- 
ment of each individual brought to the clinic for study. 

The proper organization and personnel of the clinic is essential to its 
future success. This is fundamentally a medical problem and should be dealt 
with chiefly as such. The clinic should be a part of the clinical facilities of 
the General Hospital. 

The director of the clinic should be a full-time man. He should be a 
physician with ample clinical experience, who has specialized in psychiatry, 
with special reference to the social phases of the problem, who has had 
special training in psychology, sociology, and in social work, and who is par- 
ticularly well acquainted with the application of these sciences to the problems 
of delinquency, dependency, public health, industry and education. 

The clinic should have an intimate contact with the General Hospital and 
the University. The training of medical men in clinical psychiatry and in 
mental hygiene is one of the greatest needs in medicine today. No small 
amount of chronic invalidism amongst the patients that fill physician's offices, 
is due to the ignorance of doctors about psychiatry. This ignorance is also one 
of the main reasons why quackery flourishes. 

Finally, when we realize that mental disease is in a large measure pre- 
ventable, and that no other person has the opportunity that the physician has 
of coming in contact with early and mild cases at a time when treatment and 
prevention are possible, we can appreciate how important is the training of 
young medical students in psychiatry. 

Of just as much importance, possibly of even greater importance, is the 
training of future school teachers along mental hygiene lines. Courses giving 
the principles of mental health and the fundamentals of mental hygiene, 
should be part of the training of every student preparing for the teaching 
profession. 

We can readily see how important a role the public school teacher plays 
in the mental health of the nation, if we remember that the first evidences of 
criminal conduct and of mental disease show themselves in childhood. A 
proper understanding upon the part of those who come daily in contact with 



MENTAL HYGIENE SURVEY OF CINCINNATI VH 

the maladjusted child of the full import of unhealthy adjustments, may serve to 
prevent later shipwreck. 

Most persons are fully convinced that any fundamental change in our pro- 
cedure of dealing with criminals in court, must come about through the 
training of future lawyers and judges in our law schools. All of the accumu- 
lated fund of knowledge about the causes for criminal conduct and the indi- 
viduals who commit crime, is as yet an uncharted sea for the majority of our 
law schools. 

It can be seen, then, that the director of this clinic, which will serve the 
city in connection with its problems of mental disease and mental defect, 
juvenile delinquency, adult crime, dependency, and the like, should be part 
of the teaching staff of the University. He should be a professor of psychiatry, 
and should give courses of lectures in the medical schools, in the law schools, 
and in connection with the training of school teachers and social workers. 

RECOMMENDATIONS 

1. The most important issue presented in this report, in our belief, is the 
need for a Central Psychiatric Clinic, which will serve the social agencies, 
courts and institutions of Cincinnati in studying, advising and treating the 
large number of mentally handicapped persons who provide us with the appar- 
ently unimprovable cases of delinquency and dependency; which will serve 
the public schools in the study and treatment of psychopathic children, and 
the problem cases of mental maladjustment and conduct disorders which 
are daily coming to the attention of public school authorities; and finally, 
which will serve the general community, the mentally sick and maladjusted per- 
sons in the homes of Cincinnati, who, if not properly understood and given 
suitable treatment today, will provide us with next year's cases at Longview 
and various private sanitaria. 

2. The director of the psychiatric clinic should be professor of psychiatry 
and mental hygiene in the Medical College. Laying aside the issues of insanity, 
mental defect and epilepsy, all of which are so important to consider in 
connection with a course in psychiatry in the medical school, there are other 
conditions more numerous and more fundamental that are to be thought of in 
the training of medical students. Every case with which the physician has to 
deal is a problem in mental adjustment; the mental attitude of the patient, his 
adaptation to his own individual problems and to those presented by his envir- 
onment, is an all important question in his permanent recovery. We have 
mentioned before the large flock of psychoneurotic individuals and mental 
invalids who fill doctor's offices, and who supply quacks with a means of 
sustenance. These conditions are due in large measure to the ignorance of 
physicians concerning psychiatry and the most elementary principles of mental 
hygiene. 

There is a growing demand throughout the country which cannot be filled 
by the graduates of our medical schools or by members of the staffs of our state 
hospitals for the insane, and that is for physicians trained in the field of social 
psychiatry and mental hygiene, who can undertake work in connection with 
clinics in juvenile and adult courts and in public schools. This demand is very 
great at present and there are practically no men trained to do the work. The 
next few years will see an immense development along these lines, for public- 
school officials, judges, institution authorities and heads of organized social 
agencies throughout this country are calling more and more for assistance in 
this direction. It is not enough to be able to say whether a criminal or a 
dependent is insane or mentally defective. The large proportion are neither. 
The public is now demanding that the sciences of psychiatry and psychology 
be applied to the problems of delinquency and dependency as such; enough is 
already known of the causes of human failure through the contributions of 
these two sciences to justify such a demand. 

The training of medical students in the University along these lines should 
certainly be a fundamental part of the medical school's curriculum, this train- 



102 MENTAL HYGIENE SURVEY OF CINCINNATI ___ 

ing to consist not only of lectures in the University, but of practical work in 
the clinic. 

3. Real supervision of mentally defective children is urgently needed. 
This should be extended to cover the after-care of psychopathic and epileptic 
children, the last two named to be supervised in connection with the proposed 
psychiatric clinic; but the actual work of supervision to be conducted by the 
Vocation Bureau. This type of work — the supervision of defective, psycho- 
pathic and epileptic children — requires full-time, well paid social workers. 
These individuals should have training along psychiatric lines; for the service 
is of the most expert kind, requiring an appreciation and knowledge of the 
limitations as well as the abilities of these children. 

4. Extending further the splendid facilities of the Vocation Bureau, 
for the particular type of work that this organization is doing for the public 
school system of Cincinnati. 

5. Increased and continuing support of the special-class facilities in the 
public schools. The public school system cannot be praised too highly for its 
work in this direction. More stress should be laid on industrial and voea-7 
tional training of mental defectives than is now being done. The equipment 
along these lines is inadequate; a small financial outlay in fitting the defective 
child for a job in life is real economy. 

6. This survey shows that the children at the two Opportunity Farms 
are largely a selected group, handicapped in a great many instances by serious 
mental and physical conditions. It is clear from this study that these children 
are not able to profit by measures ordinarily used in training normal persons. 
The problem presented from an educational point of view is to fit these indi- 
viduals for something useful in life, to equip them with the sort of training 
that will enable them to secure, and hold, a job and support themselves. 

More should be made of this phase of work in both institutions. We recom- 
mend the placing of the two Opportunity Farms under the administrative con- 
trol of the Board of Education. All of the problem children in these two 
delinquent institutions, particularly the psychopathic boys and girls, should 
receive the most intensive and thorough-going study by the staff of the central 
psychiatric clinic. The treatment and training of these particular children 
should be based upon the findings of the clinic in each case. 

7. Great progress has been made in handling first offenders and misde- 
meanants through the development of adult probation. We will not endeavor 
to go into this matter except to state that, in some parts of this country, courts 
have found that many offenders may be handled safely out in the community 
and thus the cost of their support in institutions be completely saved, to say 
nothing of the reclaiming, in many instances, of the individual himself. 

In Massachusetts every court is compelled by law to have a probation 
officer. This work is growing to such an extent in that state that the great 
majority of all offenders are now being handled by other than institutional 
measures. The judges of the Municipal Court of Cincinnati should be supplied 
with an ample number of probation officers to serve that court. 

8. Any permanently successful endeavor, no matter how worthy, must 
ultimately be based upon public education. This is particularly true in the 
field of mental hygiene. The subject consists of a mass of knowledge with 
which as yet the general public is entirely unacquainted. There is also a vast 
amount of misinformation that must be uprooted before any real progress can 
be made in preventing insanity, mental defect, epilepsy and the mental factors 
involved in delinquency, dependency and human failure, or in maintaining 
mental health in otherwise normal persons. 

There is an urgent need of a continuing service, along educational lines, 
of the general public as to this phase of health work. Such service can best 
be accomplished through the organization of a mental hygiene committee or 
society that will carry on an educational campaign, hold public conferences, 
present exhibits, distribute mental hygiene literature, and bring to bear upon 



MENTAL HYGIENE SURVEY OF CINCINNATI 1M 

public authorities a sound influence pertaining to measures that come within 
the scope of mental hygiene work. A Mental Hygiene Council of the Public 
Health Federation has already been established to serve this purpose. Its work 
should be continued and adequately financed. 

EDUCATIONAL NEEDS WHICH SHOULD, IN THE 
FUTURE, ULTIMATELY BE MET 

(a) If the most important element in the prevention of crime, depen- 
dency, mental breakdowns and human failures is to be found in the early 
recognition and individual training and treatment of the unadjusted and 
maladjusted school child, then the part that the school teacher has to play 
in the mental health of the nation is, next to that of the parents, probably 
the most important. Training the special-class teachers and special-class 
supervisors in the University is essential. The present training should be 
supplemented by systematic courses in mental hygiene. This can only be 
done by those who are intimately acquainted with the problems of mental 
defect and other mental conditions. The director of the proposed psy- 
chiatric clinic should be professor of psychiatry in the University and 
should conduct courses along mental hygiene lines. To all individuals who 
expect to take up teaching as a profession, courses should be given dealing 
with the fundamental principles of mental hygiene, and here we are not re- 
ferring so much to the question of special-class training, as we are to the 
general problems of mental health, with which every teacher should be well 
acquainted if she is to play the part that she should play in the proper con- 
servation of the mental health of children. 

We have pointed out frequently through the entire report how the 
beginnings of adult failures are noticeable very early in the public school 
child. The important thing to stress is that these children in a large measure 
can be adjusted and developed into successful and happy men and women. 
The part the teacher has to play in this is of the first consideration. 

A responsibility rests on the shoulders of the University authorities to 
prepare teachers along these lines. 

(b) There is a growing tendency towards individualization in social 
work. Almost all case working agencies are now stressing the value of 
training in psychiatric social work. Many persons have begun to feel that 
in our dealing with general social problems, we have been in the habit of 
overlooking the most important element in the whole situation, and that is 
the individual himself, with whom we are dealing as a dependent or a de- 
linquent or as a case needing some sort of social interference. So it has 
come about that various colleges and universities in this country have 
developed courses in psychiatric social work. The demand for persons 
trained along these lines far exceeds the supply. State hospitals for the 
insane, the American Red Cross, psychopathic hospitals, psychiatric clinics, 
clinics in courts, in public schools, and institutions dealing with delinquent 
individuals, as well as probation departments in courts and various social 
agencies are seeking the services of psychiatric social workers. 

It is recommended that the University develop such a school in psy- 
chiatric social work, and that the director of the proposed clinic, assisted 
by the chief psychiatric social worker of the clinic be charged with the 
duty of conducting the courses in such a school. 

Note. — It may be added here that the amount of teaching referred to 
upon the part of the director of the clinic would hardly be noticed in the 
routine of his general work, not requiring, all told, more than two to 
four hours a week. 

(c) That phase of this report dealing with the subject of delinquency 
has brought out some very significant facts concerning criminals and the 
prevention of crime. We have suggested a program that has its basis in 
the study of criminals and their treatment rather than punishment. In 
this way insane, mentally defective and grossly handicapped prisoners 



104 MENTAL RYGIENE SURVEY OF CINCINNATI 

would not be found in court time and time again, serving repeated sentences 
in institutions, but would be committed to those institutions and hospitals 
best suited to their particular needs. Such a program, we believe, would 
make great strides in the prevention of recidivism (repeated criminal 
conduct). 

The disposition of criminals and the protection of the public from 
their depredations is largely in the hands of the courts. Judges should be 
familiar with the facts concerning mental defect, epilepsy, insanity, and 
other mental conditions which are determining factors in criminal conduct. 
They should be taught in the law schools that in the case of each individual 
offender who appears in court, there are many other, and probably more 
important considerations, involved than the purely legal questions; con- 
siderations that have everything to do with explaining why a particular 
individual commits a criminal act, and above all in explaining how best 
society may be protected from a future repetition of such conduct. 

Courses in the law school dealing with the subjects of delinquency 
and the psychopathology of crime should be conducted by the professor 
of psychiatry and mental hygiene. Any real progress in attacking this prob- 
lem at its very source in the courts must depend upon the education Of 
future judges. 



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PART II 

STUDY OF THE FEEBLEMINDED 



Study of the Careers of 322 Feebleminded 
Persons in Cincinnati 

AND 
A State Mental Hygiene Program 



V. V. Anderson, M. D. 
Flora May Fearing 



A STUDY OF THE CAREERS OF 322 FEEBLEMINDED 

PERSONS 



The object of this study was to determine what happens to mental 
defectives after they leave the public schools and go out into the com- 
munity to earn a living. It was hoped that this information showing why 
some fail and some succeed in adjusting themselves to the conditions of 
normal life in the community, together with the facts obtained from our 
study of several thousand public school children, dependents coming in 
contact with social agencies, paupers in city and county homes, delinquents 
in courts and institutions in Cincinnati and Hamilton County, would enable 
us to map out a comprehensive state program for dealing with feeble- 
mindedness. 

Most of the information on the subject and most of the resulting legis- 
lation have been based on generalizations from studies of striking failures, 
such as feebleminded criminals, feebleminded vagrants, feebleminded pros- 
titutes, and feebleminded dependents. If the careers of these human derelicts 
are fairly representative of mental defectives as a whole; if the dishearten- 
ing, depressing picture they paint tells the entire story, then only one thing 
remains to be done and that is to segregate all of them for life. 

But even this is not so simple as it seems. If we bear in mind that 
approximately one per cent of the general population is mentally defective 
and that the army figures showed that mental defect was three times as frequent 
as insanity in the army of three million men, we may begin to appreciate 
the size of the problem. The cost of maintaining all of these individuals 
in state institutions makes such a program prohibitive. It is not believed 
any legislature would undertake so vast an appropriation of public funds. 

But then the question arises, is it all necessary; are all feebleminded per- 
sons vicious, immoral, dependent, delinquent, and prolific in reproducing 
themselves? If not, what are the facts? As it is, we must, from the very 
nature of the case, select some more feasible program than segregation 
of all mental defectives. 

We have then set out to determine if many generalizations about feeble- 
mindedness will hold water. In the first place we have found that two 
per cent of the public school children are mentally defective, and that men- 
tal defectives in large numbers furnish us with unimprovable cases of de- 
pendency and delinquency; but not all mentally defective school children 
become dependents or delinquents, prostitutes or vagrants. In the light 
of these facts we wished to know then why some feebleminded children 
become a menace to the general public and furnish some of the most serious 
cases with which our social agencies and institutions have to deal, while 
others seem never to give any trouble and become decent, respectable, self- 
supporting citizens. We believed that only with such information at hand 
would it be possible to plan an intelligent and comprehensive state program 
for dealing adequately with the question. For this purpose two groups were 
chosen for study. The first group consists of 201 ex-students of special classes 
for mental defectives in Cincinnati. These individuals had been made the 
subject of an investigation in 1918. At that time the histories of all children 
enrolled in classes for defectives in Cincinnati who had been out of school 
for as much as a year were studied. The results were published by Helen 
T. Woolley and Hornell Hart in Vol. I., Number 7, Studies from the Helen 
S. Trounstine Foundation. 

At that time there were 203 such children. The intention from the first 
had been to send only definitely feebleminded children to the Special Schools. 
Before the establishment of the Vocation Bureau, however, there were inade- 



108 A STUDY OF THE FEEBLEMINDED 

quate facilities for examination and diagnosis and many were selected largely 
on the basis of the judgment of the teacher. This resulted in some being 
included in the group who were not feebleminded and others being sent 
because of special defects, chorea, etc. The group as a whole, however, 
can in all justice be called "defective." For this group the findings resulting 
from the previous study covered the following points: 

Mental, Educational, and Social Status, including relation of mental 
age and chronological age, length of stay in special school, family 
records with Social Agencies, social maladjustments noted in the 
family. 

History after leaving school, including use of leisure time, delin- 
quency, social and economic status, analyses of special groups — 
individuals living at home, individuals in institutions, individuals 
who married. 

Industrial record, including amount earned, length of time in 
positions, type of work. 

The chief purpose of this former study was to evaluate the training 
received in the special classes provided for the mental defectives in Cin- 
cinnati. Had they gained in personal resources as well as in industrial 
efficiency from such training; how should future educational policy for 
such individuals be modified? 

For the present study, the same cases were taken and much of the 
material secured in the former investigation was transcribed on our statis- 
tical sheets. An effort was made to bring to date the histories of these 
individuals and to add some special studies not attempted before. At present 
the ages ranged from 18 to 30, the median chronological age being 22.2 
years, so that the facts should be more far-reaching as the amount of time 
that has elapsed may be considered to be a fair tryout. 

The second group consists of 121 individuals who had been diagnosed as 
feebleminded by the Vocation Bureau during the years 1917-1919. At the time 
of examination they presented no particular maladjustments other than 
school retardation. Their examination had been requested by either the 
work certificate office or the placement office or school principal or social 
agencies. At present they are all out of school and in the community. In 
most cases no attempt has ever been made at supervision. No social investi- 
gations had ever been made of these cases. Their ages now would be between 
16 and 22 years. 

TWO HUNDRED AND ONE EX-STUDENTS OF 
SPECIAL CLASSES FOR DEFECTIVES 

GENERAL DATA 

In 1918, 203 cases of ex-students of special classes for defectives in 
Cincinnati had been studied by Dr. Helen Woolley. During the three years 
when no work was done on these cases, two of the original sheets of data 
were lost. This meant that for our investigation there were but 201 indi- 
viduals. All of these had been out of school for at least four years. Many 
of them for a much longer period. 

Of the whole group studied, 188 or 93.5 per cent were found to be 
native-born, 161 or 80.1 per cent of native parents; 8 or 4 per cent were 
foreign-born. For five individuals it was impossible to secure information 
on this point. Nine or 4.5 per cent were negroes. The whole group is 
thus made up very largely of native-born individuals; language difficulty and 
inability to adapt themselves to American social environment, therefore, 
being a factor only in a negligible number of cases. This homogeneity 
makes the data on the industrial history of these individuals much more 
significant. All but eight are native-born and all but nine are white. 



A STUDY OF THE FEEBLEMINDED 



109 



When actual investigation was begun it was found that eight had died 
since leaving school; three had been definitely diagnosed as psychotic. There 
were six individuals who had had later psychological examinations and 
were diagnosed as not feebleminded. These 17 cases were automatically 
eliminated from this study of the feebleminded out in the community. When 
the whole study was finally brought to an end, two of the women had not 
been located. No clue as to the whereabouts of either the individual or 
of any member of the family had been found. There were also five indi- 
viduals about whom insufficient data were gathered to make practicable 
their inclusion in this study. There were in all, therefore, 24 cases eliminated, 
leaving a total of 177 feebleminded individuals whose histories since they 
left school were intensively studied. 

Of the final number studied, it was found that 113 or 63.8 per cent were 
men, and 64 or 36.2 per cent were women. 

Twenty-six of the women and 15 of the men have been married. 

The 26 married women had 39 children. Two had no children, 13 
have one child each, 3 have two children, 1 has four, and 2 have eight. The 
two who have no children were both married less than five months before 
they were interviewed for this investigation. Two of those who have had 
only one child were sterilized at the time of the birth of an illegitimate 
child. Ten of these women have been sexually promiscuous, and five others 
have had illicit relations with at least one man. Six were pregnant when 
married. 

The five girls who in the 1918 study had had illegitimate children are 
now married. In the whole group no other case of illegitimacy has occurred 
in the last three years. 

A study was made as to the location of these 177 individuals — whether 
in industry, or in institutions, or at home — not working. The present location 
for the total number, and for the men and women separately, is given in the 
following table. 

TABLE 1— PRESENT LOCATION 



LOCATION 


Males 

Number Per Cent 


Females 

Number Per Cent 


Total 

Number Per Cent 


Institution 


9 8.0 


6 
21 

26 

ii 


9.4 
32.8 

40.6 

17.2 


15 
26 

41 
11 

76 
8 


8.5 


At home, never worked 
At home, previous in- 
dustrial record .... 
Working for relatives. 

In industry 

Army or Navy 


5 

15 
11 

65 
8 


4.4 

13.3 
9.7 

57.5 
7.1 


14.7 

23.2 
6.2 

42.9 
4.5 


Total, 


113 


100.0 


64 


100.0 


177 


100.0 



Fifty-three and six-tenths per cent of the group are gainfully employed 
either in industry, in the Army or Navy, or working for relatives. From 
the above table it will be seen that only 17.7 per cent of the men are unem- 
ployed and at home; while 73.4 per cent of the women are not at present 
employed outside of their homes. Over half of the women (57.8 per cent), 
however, have been in industry at some time. Seventy-seven per cent of the 
white persons have had industrial records. 

INSTITUTION CASES 

Of the whole group there are now in institutions 15 individuals — nine 
men and six women. In 1918, 24 were in institutions — five in correctional 
institutions, and nineteen in institutions for mental defectives. During the 
three years that elapsed between the two investigations, one boy returned 
from Vineland, enlisted in the army, was discharged because of mental 



110 A STUDY OF THE FEEBLEMINDED 

deficiency, and is now at home, a member of a "pension family" of one of 
the social agencies. Another boy returned from Woodbine, the New Jersey 
Agricultural School, had a serious delinquent record and is now dead — 
killed when he attempted highway robbery. The five who were in various 
institutions for delinquents have all been released and, while in two cases 
there has been further delinquency, it was not of so serious a nature as to 
result in recommitment. Several who were in the State Institution for the 
Feebleminded at Columbus are now at home, incapable of industrial ac- 
tivity, but in no case a problem to the community. Two low-grade defec- 
tives are now on parole from Longview Hospital for the Insane. 

For the 15 individuals now in an institution, the ages range from 18 to 25. 
With two exceptions they were all placed in an institution for mental defectives 
within two years after leaving school. The number of years they have been in 
institutions varies from one to ten, the largest number having been in six 
years. 

An attempt was made to give them special training in school. Upon 
leaving school all except two failed almost immediately to make a social 
adjustment and they were placed in state or private institutions. Many of 
them were very low grade mental defectives, in seven cases the Intelligence 
Quotient being less than 50. They are not now, and have never been for any 
considerable period of time, out in the community, and are, therefore, of 
no further interest in this study. The two remaining cases are of two girls 
now at the State Institution for the Feebleminded, who were not sent there 
until, in the one case 4 years and in the other case 6 years had elapsed 
after leaving the Special School for Defectives. Both give interesting histories 
of how disastrous it is for certain types of feebleminded individuals to be 
left out in the community. 

THE CASE OF DELLE 

First year after leaving school. Worked for a few weeks at three different jobs. Never 
earned more than $6 a week. 

Second year. Married when 16. Pregnant at time of marriage. 

Third year. Child found by officer of Ohio Humane Society dying of neglect, naked, 
half starved and bruised. Action instituted to have Delle committed to State Institution for 
the Feebleminded was opposed by husband and dismissed by court. 

Fourth year. Ohio Humane Society again attempted to secure commitment and was 
again unsuccessful. 

Fifth year. Second child born. Husband, probably a mental defective, began to mis- 
treat Delle. 

Sixth year. Worked for a few weeks for $5 a week. Husband failed to support her 
and the child. Third unsuccessful attempt made to secure commitment. Child had to be 
taken from her because of neglect. Action was brought a fourth time in the court and com- 
mitment was at last secured. 

The case had been handled for four years by a social agency. Every 
possible means of securing a social adjustment had been attempted. The 
court three times refused to take her out of the community, yet she was 
incapable of caring for herself or her children. One brother had been at 
the State Institution for the Feebleminded since he was nine years old. One 
sister and another brother are definitely feebleminded. The family live in 
the most squalid of tenements. There is every reason to suppose that 
had not the officials of one social agency kept persistently on the case 
she would have been allowed to remain indefinitely in the community, giv- 
ing birth to defective children for whom she was incapable of caring. Delle 
was not only feebleminded but suffered markedly from personality difficul- 
ties. She was indolent, sluggish, weak-willed and suggestible. 

THE CASE OF NETTIE 

First year after leaving school. Brought into Juvenile Court as a sex delinquent. Placed 
in Convent of the Good Shepherd. 

Second and third years. Held two short time positions. Never earned more than $7. Was 
going constantly with one man but did not marry him. 

Fourth year. Worked at a "hotel" and became a "known" prostitute. A septic abortion 



A STUDY OF THE FEEBLEMINDED 111 

resulted in her being sent to the City Hospital. Commitment proceedings were instituted 
by the Hospital Social Service and she was transferred to the State Institution for the 
Feebleminded at Columbus. 

Four years before Nettie had been definitely diagnosed as mentally de- 
fective, and within one year after leaving school she became a sex delin- 
quent. At no time did she learn to read or write. She was a constant truant 
during her school days. The teachers reported before she left school that 
they had every reason to suppose she was guilty of sex offenses. Everything 
in her history indicated the necessity of institutional care or the most con- 
stant supervision if she were to remain in the community. Her friends at 
the "hotel" when interviewed still grieved, however, because she "got sick" 
and had been sent "up state." 

INDIVIDUALS NOW GAINFULLY EMPLOYED 

Of the 177 individuals who were made the basis of this study, 87 or 49.1 
per cent were found out in industry or were working for relatives. There 
were 41 others who, while not employed at the present time, had previous 
industrial records. In the 1918 study, these two groups were combined. 
Such marked differences, however, were apparent from our analysis of 
the industry history of the two groups that they were studied separately 
and will be contrasted rather than combined. 

In such an investigation as this in which light has been sought on the 
much befogged question of what should be done with the feebleminded in- 
dividuals who are turned out from our schools, interest centers around those 
who are making a living and have apparently made a social adjustment. 
All too frequently the correct application of the term "feebleminded" is 
deemed sufficient identification. It is forgotten that mental defectives differ 
as widely one from another as do normal individuals. Some have serious 
personality handicaps, others have none; some come from advantageous 
social surroundings, some from environments which are in themselves tre- 
mendous handicaps. It is to be expected, therefore, that even as among 
normal individuals some will "make good" and some will not. 

An attempt has been made, therefore, not only to study the industrial 
history of the group as a whole, but to endeavor to determine what factors 
have made for the success of certain individuals and for the failure of 
others. 

Information in regard to industrial history was secured in some cases 
from the Placement Office and the Work Certificate Office of the Cincinnati 
Vocation Bureau. Chief reliance, however, for this group of individuals who 
had been out of school for five or six years, had to be placed upon informa- 
tion secured from the individuals themselves or from their parents. With 
but few exceptions, at least one employer was interviewed to verify the state- 
ments in regard to wages, length of service and to give definite information 
in regard to the dependability and general work history of the individual. 

Of the 87 individuals now gainfully employed in industry, information 
in regard to wages, which could be used statistically was secured for only 
69. Eleven are now working for relatives, and though the amounts paid 
them are known, it was felt unwise to include these wages with those paid 
by industrial concerns; others are now working in other cities, and relatives, 
when interviewed, could not give trustworthy information. The median 
wage for these 69 cases is $15.08. The amounts paid vary from $5 a week 
to $37 a week. Over one-third are now receiving between $10 and $15 a 
week; while approximately 50 per cent are receiving wages of more than 
$15 a week. 



112 



A STUDY OF THE FEEBLEMINDED 





TABLE 


II— SCHOOL 


RETARDATION 






RETARDATION 


MALES 


FEMALES 


TOTAL 




Number 


Per Cent 


Number 


Per Cent 


Number 


Per Cent 


Retarded 1 year. . 


.. 30 


27.5 


5 


10.4 


35 


22 3 


None 


.. 33 


30.3 


9 


18.7 


42 


26.8 


Retarded 2 years. 


.. 27 


24.8 


18 


37.5 


45 


28.7 


Retarded 3 years. 


... 11 


10.1 


8 


16.7 


19 


12.1 


Retarded 4 years. 


.. 7 


6.4 


4 


8.3 


11 


7.0 


Retarded 5 years. 


.. 1 


.9 


3 


6.2 


4 


2.5 


Retarded 6 years. 














Retarded 7 years. 







1 


2.1 


i 


0.6 



TOTAL 109 100.0 48 100.0 157 100,0 

Dividing the cases according to those who have, and those who have 

not, character defects and handicaps of personality, we find that the median 

wage for those with no personality difficulties is $17.50 per week; while 
for those with personality difficulties the wage is $12.85. 

TABLE III— BEHAVIOR HISTORY 

BEHAVIOR BOTH MALES FEMALES 

Number Per Cent Number Per Cent Number Per Cent 
No outstanding 

Behavior Difficulties.. 29 18.5 24 22.1 5 10.4 

Stealing 44 28.1 42 38.5 2 4.2 

Pugnacity 15 9.5 12 11.0 3 6.2 

Sex delinquency 25 15.9 25 52.1 

Sex perversion 5 3.2 5 4.6 .. .... 

Lying 7 4.4 4 3,7 3 6.2 

Incorrigible 7 4.4 2 1.8 5 10.4 

Gambling 2 1.3 2 1.8 

Truancy 18 11.5 14 12,8 4 8.3 

Vagrancy 5 3.2 4 3.7 1 2.1 

TOTAL 7l57 10CU3 109 100.0 48 100.0 



LENGTH OF TIME IN ONE JOB 

Information sufficiently accurate to be used statistically was obtained 
in 72 cases, on the length of time that had been spent in the various positions 
held. 

TABLE IV— LENGTH OF TIME IN ONE JOB FOR 72 OF THOSE NOW IN' 

INDUSTRY 



TIME 
5 months 
months 



In Present Job 
Number Per cent 



Average Time 
Number Per cent 



1 

6—11 
12—17 months 
18—23 months 
24—35 months 
36 months and over 

Total, 



18 


25.0 


17 


23.6 


12 


16.7 


14 


19.4 


9 


12.5 


10 


13.9 


4 


5.6 


9 


12.5 


13 


18.1 


8 


11.1 


16 


22.2 


14 


19.4 



72 



100.0 



72 



100.0 



Fifty-eight and four-tenths per cent of these individuals have been in 
one position for more than a year, while 40.3 per cent have held their present 
position more than two years, and 22.2 per cent have held their position 
three years or more. 

Those individuals who are handicapped by some difficulty of personality 
are more likely to lose their positions, or to remain a shorter period in one 



A STUDY OF THE FEEBLEMINDED 113 

place of employment, than those who are not so handicapped. The median 
number of months in the present job for those without personality difficul- 
ties is 19.5 months, for those with personality difficulties is twelve months. 

TYPE OF WORK 

A wide variety of occupations appears from the study of what these 
individuals are now doing (factory work, machinist, day laborer, driver, struc- 
tural iron worker, helper on wagons, auto mechanic, painter, news vender, 
farmer, errand boy and salesman) six were engaged in construction work, 
eight as machinists, 27 are working in factories, three as salesmen, 21 are 
employed at odd jobs, and the remainder are working as apprentices, farmers 
and clerks. 

SEX AND RACE AND INDUSTRIAL HISTORY 

There are at present, no colored women in this group employed in indus- 
try. There are four colored men who are employed at unskilled labor. One 
is a day-laborer and three do odd jobs. One of these individuals has been 
employed as a helper on a wagon for 22 months, and he earns $10 a week. 

Nine of the 11 women out in industry are employed in factories, one is a 
filing clerk and one does kitchen work. 

The median present wage for the women is $12.50 per week; while that 
for the men is $15.50. 

THOSE WHO HAD A PREVIOUS INDUSTRIAL HISTORY BUT ARE AT 

PRESENT UNEMPLOYED 

In all there are 41 individuals who now are at home, but who have prev- 
iously been out in industry — 15 are men, and 26 are women. The reasons 
which they give for being at home are varied. Eight of the women stopped 
work when they married, six stopped before the birth of their first child; 
21 individuals (men and women) are simply "out of work;" while six men are 
now in the army. 

In general these individuals received poorer wages, and remained shorter 
periods of time in positions, than the group who are now in industry. 

TABLE V— WAGES RECEIVED OF 69 OF THOSE NOW IN INDUSTRY AND 
OF 37 OF THOSE PREVIOUSLY EMPLOYED 

Those Pre- Those Pre- 

now in viously now in viously 

industry employed industry employed 

Amount per Week 

Last Wage Average Wage 

$lto$4 4 .. 3 

5 to 9 9 13 15 19 

10 to 14 25 10 29 9 

15 to 19 13 5 14 5 

20 to 24 12 2 7 1 

25 and over 10 3 4 

TOTAL 69 ~~37 ~~ 69 ~~37 

The average wage for these two groups presents interesting comparisons. 
Sixty per cent of those now at home and unemployed but who have previously 
been employed, averaged less than $10 a week when they were employed; 
while approximately 50 per cent of those now in indusry average more than 
$15 a week. 

Eighty-six per cent of those who are now at home, but who have had a 
previous industrial career, averaged less than a year in the jobs which they 
held; while the majority of those now in industry, 58.4 per cent, have averaged 
more than a year per job. 



114 A STUDY OF THE FEEBLEMINDED 

THOSE AT HOME WHO NEVER WORKED 

There are 21 women and five men who have never worked outside of the 
home. They fall immediately into two groups. First, those with so low a 
grade of intelligence — imbeciles and idiots — that they are incapable of employ- 
ment, no matter how great the economic need; and second, those who come 
from homes where there has been no urge to go out into industry, where they 
have led quiet, and uneventful lives, surrounded by a fair degree of comfort. 

Very few of these individuals have given evidence of any serious behavior 
difficulties. With one or two exceptions they have presented no real social 
problems. 

COURT AND INSTITUTIONAL RECORD 

It will be remembered that of the 177 cases included in this study, 15 were 
in institutions for the feebleminded. This leaves 162 for whom a special study 
was made as to any evidence of delinquency. 

Only 36 individuals (22.2 per cent) have court or institutional records 
(correctional), This certainly does not indicate that the majority of feeble- 
minded children are liable to become criminals, even if not supervised. It 
seems as if we will have to revise our conception as to the meanness and vic- 
iousness of feebleminded persons. It may be interesting to note that prac- 
tically all of the individuals who had a delinquent record were likewise 
handicapped by personality difficulties and character defects. It is our belief 
that we need to know more about a person than the mere fact that he is feeble- 
minded, if we are going to make any predictions as to his conduct later on in 
life. This study is but in keeping with our experience from other investiga- 
tions, that by far the largest factor in delinquent behavior, as far as the indi- 
vidual's make-up is concerned, is not to be found in his degree of intelligence 
but in his character and personality. 

A STUDY OF THE HOMES 

HOME INDEX 

It will be remembered from our former study of problem school children 
and juvenile delinquents, that in our social investigations of the home we 
endeavored to evaluate certain factors and give a final index. If the index was 
20 or over, we felt that the general conditions were very favorable for the 
best interests of the individual; 18 was found to most frequently represent the 
typical middle-class home; an index below 13 indicates unfavorable home 
conditions; while an index of nine or below represented a very low social 
level. 

The distribution of the indices given for 136 homes investigated is as 
follows: 

TABLE VI— DISTRIBUTION OF 136 HOME INDICES 

Index Number Per Cent 

21-24 9 6.6 

17-20 34 25.0 

13-16 37 27.2 

9-12 37 27.2 

5-8 19 14.0 

TOTAL 136 100.0 

Thirty-one and six-tenths per cent of these individuals live in homes which 
grade 17 or above — that is in good middle-class homes or even better; 41.2 per 
cent, however, live in homes which grade 12 or below and offer distinctly 
unfavorable surroundings; 14 per cent live in the very lowest grade homes. 
The chief failure in the homes of these individuals was found in parental 
conditions. Twenty-three per cent received the very lowest possible score on 
this item. The general intelligence, social adaptability and harmony between 
the parents received the very lowest rating. Thirty per cent of these mental 



A STUDY OF THE FEEBLEMINDED 115 

defectives have little or no parental supervision or control. One-third of the 
homes are too crowded for even a fair degree of comfort and privacy. Eight 
families were found in actual destitution. 

NEIGHBORHOOD INDEX 

Each neighborhood visited was scored in the same way as were the 
homes. The distribution of these values for the whole group is given below: 

TABLE VII— DISTRIBUTION OF NEIGHBORHOOD INDICES 
FOR 146 HOMES 

Index Number Per Cent 

21-25 22 15.1 

17-20 25 17.1 

13-16 72 49.3 

9-12 19 13.0 

5-8 8 5.5 

TOTAL 146 100.0 

Nearly half of the cases live in neighborhoods scoring between 12 and 17. 
Such an index indicates a fairly favorable neighborhood environment. 

CONTACT WITH SOCIAL AGENCIES 

All cases were cleared with the Confidential Exchange. The records of 
the social agencies registered were read and a study was made of the regis- 
trations. 

While our former conclusion was that the feebleminded individual is not 
as bad as we have accused him of being, and does not become a criminal so 
frequently as we have been led to believe, nevertheless, he or his family in 
the great majority of cases present some sort of a social problem to the 
community — this is usually along the lines of relief or dependency; 70 per cent 
of these cases come from families which have registrations with the social 
agencies of Cincinnati; 13 per cent come from families which have registrations 
with more than six social agencies. 

A great many types of social maladjustment were found in members of 
the families of these defective children — alcoholism, delinquency, illiteracy, as 
well as actual mental disease and mental defect, epilepsy, and the like, were 
found quite frequently. In all 380 such maladjustments were found in the 
families of these 162 individuals. More than one-third of the maladjustments 
were noted under the head of mental defect — 37 sisters and 35 brothers had 
been diagnosed feebleminded; 38 fathers and 9 mothers were known to be 
alcoholic; 7 mothers were sex delinquents; 5 mothers were suffering from 
epilepsy; 10 fathers and 12 mothers were illiterate, etc., etc. 

One interesting thing that stood out in this investigation, was that those 
children handicapped by personality difficulties and serious psychopathic 
conditions, came almost invariably from families where there were a great 
number of social maladjustments; while those children free from these handi- 
caps came from the best type of families, most industrious and socially adjusted 
parents, where home conditions were good. 

Illustrative cases showing two sides of the picture — the feebleminded girl 
who is a menace, and the feebleminded girl who is an asset to the community. 

CASE 9. A girl was married at the age of 16, had a baby at time of marriage. Her 
family had had contact with social agencies. Her Intelligence Quotient is 71. She spent four 
years in a special school. She now has 2 children. Since the birth of the first child she has 
had "spells" which resemble epilepsy. Her father is an alcoholic. She and her husband have 
records with the Ohio Humane Society and the Domestic Relations Court. 

CASE 10. Woman — after leaving school earned $6 week in a factory, had an illegiti- 
mate child, and at the age of 17 married a man who was not the child's father. Her parents' 
family had three clearings in the Confidential Exchange. Her Intelligence Quotient is 74 and 
she spent four years in Special School. Has one child by husband. They live in one of three 



116 A STUDY OF THE FEEBLEMINDED 

worst homes visited. She is apparently incapable of caring for either her children or thej 
home in which they live. 

CASE 11. A girl was married at the age of 16. She had a baby who died. At the age 
of 19 she has already been divorced and remarried. Her Intelligence Quotient is 64. The time 
in Special School is not given. Has had two children by second husband. Associated Charities 
and Hospital Social Service registered. Has been living in Jackson County, Ky., for two 
years. 

CASE 13. A girl comes from, a family with three clearings. Her father was a drunkard. 
She worked for $5 a week before her marriage. She now has a child. Her intelligence quo- 
tient is 65 and she spent one year in the Special School. The family now has six clearings. 
Her father has deserted the family. She had a second child which the husband claims is not 
his. First child died. Neighbors reported that the mother had strangled it. Husband has left 
her. Judge refused divorce because she had been living with another man. Known to have 
lived with at least three men. Is now keeping two "boarders." A cousin who is a prostitute 
is her most intimate friend. Attempts to secure sufficient evidence to take the child from her 
have been unsuccessful. She has a feebleminded mother who protects her and will give no 
information. 

CASE 15. A girl was twice committed to the House of the Good Shepherd and is par- 
tially crippled with muscular trouble. On her family there are clearings with the Juvenile 
Court and the Free Dental Clinic. Her Intelligence Quotient is 72 and the time spent in the 
Special School is not stated. One child born two years after marriage. Is no longer interested 
in reading. History of sex offences before marriage. Mother and father live with her and. 
the home ranks high. , 

CASE 18. Is a girl who had a drunken and neglectful father. She, her mother, and 
four of her brothers and sisters had cataracts. The family has eleven clearings in the Con- 
fidential Exchange. She married at the age of seventeen. Her Intelligence Quotient is not 
given but she spent four years in the Special School. She has two children, both partially 
blind — one has frequent spasms. They live in a squalid shanty in the hills of Kentucky in 
the summer. In the winter live with her people in Cincinnati. One brother is feebleminded. 
The mother is illiterate and apparently very defective. 

CASE 19. Is a girl who had a drunken father. She worked for about $5 per week, 
had an illegitimate child and ran away from home. She is reported to be nervous and nearly 
blind. Her Intelligence Quotient is 73 and she spent four years in Special School No. 3. 
Married when 18, second child born. Blindness known to be due to congenital syphilis. She 
and her husband have five clearings with social agencies. She was a prostitute between birth 
of illegitimate child and marriage. 

CASE 23. Is that of a woman who was married at the age of 20. She has a good home. 
Her father runs a restaurant. Her Intelligence Quotient is only 52. Because of repeated 
delinquencies she was twice committed to the House of the Good Shepherd, which served little 
to modify her conduct — later she was sent to the State Institution at Delaware. She has now 
one child and is in West Virginia. 

CASE 25. A girl has an intelligence quotient of 48. Her father drinks, neglects the 
family and is sexually irregular. Her mother, who drank, died of tuberculosis in 1911. She 
has a brother who is a deserter, another who is an imbecile, and another who is syphilitic 
and feebleminded. She married at the age of seventeen. She had a syphilitic baby which 
was found wrapped in a newspaper and which later died. She was taken into court but 
efforts to commit her to an institution failed. At the last report she had reunited with her 
husband after a separation. The additional information in this case has already been out- 
lined in the discussion of the institutional cases. After four years, she was finally sent to. 
the State Institution for the Feebleminded. 

Another side of the picture is shown in the following cases: 

R. — Age 25; white; marital condition — single; Intelligence Quotient — 60; personality 
make-up, no outstanding personality difficulties or marked character defect; physical con- 
dition, good; behavior history, no evidence of misconduct or social maladjustments; contacts 
of family with social agencies, none; home index, 15; neighborhood index, 15; industrial 
history, left school when 15 years of age, has been in present position three years— is now 
earning $20 a week, has averaged 18 months in a job and has always received an increased 
wage as a result of each change, is now one of the highly skilled workers in a shoe factory. 
Employer's report, "steady, capable, efficient worker; is ambitious, and during the last three 
years has shown a real sense of responsibility." 

D.— Age 18; white; marital condition— single ; Intelligence Quotient, 58; personality 
make-up, no outstanding personality difficulties or character defect; physical condition, good; 
history of behavior difficulties, none; social agencies, one, Free Dental Clinic. The mother 
is an invalid, the home index is 15; the neighborhood index is 14. Left school when 16 years 
old, has held one job ever since she has been out of school. Began at $10 a week and, now 
at the end of two years, is earning $18 a week. She has had no children, has presented no 
social problem, but has been a decent self-supporting girl. Employer's report— "Regular and 
dependable. A splendid worker. Slow in learning, but never needs supervision. She is an 
expert packer in our cracker factory." 

M.— Age 19; white; marital condition— single; Intelligence Quotient, 64; personality 
make-up, no outstanding personality difficulties or character defects; physical condition, 
good- history of behavior difficulties, none. Family's contact with social agencies, 3, one 
dealing with dependency, and two with health. Maladjustments in the family, one, a delin- 
quent brother Home index, 18; neighborhood index, 16. Industrial history, left school when 
16 has had only one job. Began work three years ago basting in a tailor shop at $12 a week, 



A STUDY OF THE FEEBLEMINDED 117 

is now assistant floor lady in the same establishment and is receiving $22.50 a week. Em- 
ployer's report — "Steady, good worker. Can operate any machine. If she is shown a thing 
once she always remembers it. Is a splendid teacher of other girls." 

These three cases illustrate a group of cases which we have come across 
in this investigation that have led us to believe that feebleminded persons, if 
properly trained, may be a real asset rather than a menace to the community. 

SUMMARY 

Of the 203 ex-students of special classes for defectives in Cincinnati that 
were studied by Dr. Woolley in 1918, the records of two have been lost, eight 
individuals have died since leaving school, three have become insane, six 
persons, on further investigation, were found not to be feebleminded, two 
could not be located, and in the case of five individuals the data gathered was 
insufficient to warrant including them in this later study. There are in all 
then, 26 cases eliminated from the entire number, leaving 177 that will con- 
stitute the basis for this investigation. 

Eight and five-tenths per cent of these persons are in institutions; 14.7 per 
cent are at home and have never worked; 23.2 per cent are at home but have 
a previous industrial record; six and two-tenths per cent are working for 
relatives; 42.9 per cent are in industry gainfully employed; four and five- 
tenths per cent are in the army and navy. 

Sixty-three and eight-tenths per cent were men and 36.2 per cent were 
women. 

Twenty-six of the women and 15 of the men have been married. There 
were 39 children born to the 26 women. 

The wages received varied from $5.00 a week to $37.00 a week. Approxi- 
mately 50 per cent are receiving wages of more than $15 a week. Those indi- 
viduals not handicapped by personality difficulties and character defects re- 
ceived much larger wages than those so handicapped. 

Fifty-eight and four-tenths per cent of the group have been in one posi- 
tion for more than a year; while 40.3 per cent have held their present positions 
for two years or more. Those individuals handicapped by personality difficul- 
ties held their positions only for short periods; while practically all of those 
individuals holding positions for two and three years were in a large measure 
free from serious personality difficulties. 

A wide variety of occupations appears to have been followed by these 
persons. They were by no means limited to odd jobs and the work of day 
laborers. Six were engaged in the building trades, eight as machinists, 27 were 
working in factories, three as salesmen, etc. 

We have to revise in a measure our conception of the frequency of crimin- 
ality among feebleminded persons. Only 22.2 per cent of this group came in 
contact with any correctional agencies (courts and delinquent institutions.) 
Practically all of these cases were grossly handicapped by personality diffi- 
culties and character defect. It is our belief that we need to know more about 
a person than the mere fact that he is feebleminded if we are to make any 
predictions as to his criminal conduct later on in life. 

Thirty-one and six-tenths per cent live in homes which graded 17 or 
above, that is, in good middle-class homes or even better, while 41.2 per cent 
live in homes grading below 12, and offer distinctly unfavorable surroundings. 

While these individuals have not in many instances been delinquent, yet, 
they come from families which have furnished many and varied social prob- 
lems to the community. Seventy per cent of these cases come from families 
which have registrations with social agencies in Cincinnati. 



ONE HUNDRED AND TWENTY-ONE MENTAL 
DEFECTIVES 

For this study it will be remembered that all individuals diagnosed as 
feeble-minded by the Cincinnati Vocation Bureau during the years 1917-19 
who would now be between the ages of 16 and 22 were taken for investigation. 



118 A STUDY OF THE FEEBLEMINDED 

Many of these had been examined at the request of the Work Certificate 
Office and of the Placement Office, others were referred by school principals, 
and others were sent by the various social agencies. In all there were 156 such 
cases. 

CASES ELIMINATED 

For some of the cases examined in 1917 and 1918, there was no identi- 
fication aside from the name of the individual, and his address. When no 
names of others in the family were given and the address proved to be that 
of a Ninth Street boarding house it was only by the rarest good fortune that 
the present location of the individual was learned. There were therefore 32 
cases which were finally eliminated from the study as "impossible to locate." 
If a longer time could have been given to the work undoubtedly some of these 
need not have been eliminated. One individual who was diagnosed five years 
ago as feebleminded has since developed mental disease (Dementia Praecox.) 
Two were found to be in school and were therfore not included in a study of 
feebleminded out in the community. Thirty-five cases in all, were eliminated 
leaving 121 for which fairly comprehensive data have been secured. 

GENERAL DATA 

NATIONALITY AND RACE 

The group as a whole is made up largely of native-born individuals of 
native-born parents. One hundred and eleven, or 91.7 per cent were native- 
born. Only 10, or eight and three-tenths per cent were foreign born. Seventy- 
eight and five-tenths per cent were white and 21.5 per cent were black. Forty- 
six are men and 75 are women. Only 19 have been married (18 women and 
one man.) Only two of the women who have not married have been sexually 
promiscuous. Only one of the married women is now separated from 
her husband. She is considered a prostitute. 

The present location of the entire group is shown in the following table: 

TABLE I— PRESENT LOCATION 

TOTAL 

Location Males Females Number Per Cent 

Institution 4 4 8 6.6 

At home 9 36 45 37.2 

In industry 31 35 66 54.5 

Army or Navy 1 1 0.8 

No information 1 . . 1 0.8 

TOTAL 46 75 121 lOOJ) 

Sixty-six individuals or 54.5 per cent are now employed in industry, and 
there is a record of previous industrial activity for an additional twenty. In 
short, 86 of the total 121 have at some time been in industry. 

Sixty-two per cent of the total number of cases were handicapped by some 
personality difficulty or character defect. It is interesting to note that almost 
half of those in industry showed no personality difficulties, no evidence of 
character defect; while nearly two-thirds of those not employed showed 
such handicaps. As would be expected, those in industry have a much 
higher degree of intelligence than those unemployed, there being an average 
of approximately ten points difference in the I. Q.'s. 

TYPE OF WORK 

A variety of occupations appears from a tabulation of the various kinds 
of work these 66 individuals are doing. They may be divided for purposes of 
classification into the following groups: eight are sales-people, wrappers and 
shop girls, 33 are employed in factories, 12 are messengers, bell boys, etc., 5 
are employed in house work, 3 are working for relatives, 5 are appren- 



A STUDY OF THE FEEBLEMINDED 119 

tices, printers, etc. The distribution of these types of employment between 
the men and women — and white and colored — is as follows: 
TABLE II— TYPES OF WORK OF MENTAL DEFECTIVES IN INDUSTRY, 
CLASSIFIED ACCORDING TO RACE AND SEX 
Work White Colored Males Females 

Salespeople 8 .. 5 3 

Factory 31 2 7 26 

Odd jobs 10 2 12 

Relatives 3 . . 3 

Housework 5 1 4 

Unclassified 5 .. 3 2 



TOTAL 57 9 31 35 

All of those doing house work are colored. All of those under the heading 
of sales people are white. 

WAGES RECEIVED 
The wages received is shown in the following table: 

TABLE III— PRESENT EARNINGS OF 62 OF THOSE NOW IN INDUSTRY, 
CLASSIFIED ACCORDING TO PERSONALITY 

No With 

Amount Per Week Personality Personality 

Difficulties Difficulties 

$5 to $9 7 7 

10 to 14 13 21 

15 to 19 7 6 

Over $20 1 



TOTAL .... 28 34 

It is seen from this table that 48 cases out of the 62 on whom information 
was secured have wages averaging $10.00 per week and up to $22. The only 
person earning over $20.00 a week is an individual who suffered from no 
particular personality difficulties or character defect, eight of the 28 without 
personality difficulties were earning between $15.00 and $20.00 a week; only 
six of the 34 with personality difficulties are earning this much. 

LENGTH OF TIME IN PRESENT EMPLOYMENT 

The following table shows the length of time these individuals have 
remained in their present employment: 

TABLE IV— LENGTH OF TIME IN PRESENT POSITION OF 63 OF THOSE 

NOW IN INDUSTRY, CLASSIFIED ACCORDING TO 

PERSONALITY MAKE-UP 











>> 


>> 


























a 


"3 






>> 






o 


o 


















j; 


^3 






<u 


u 




a 


a 

S f> 


« 


^ 




&t« 




S 


o « 




a 


U 4> 


_. « 




c« 2 


3 


a 


C£ 


J2-~ 










o 








o 
6 


% 3 

eg 


•a 


© 

s 


— £ 


£2 


"« 


Z 


Zt3 


»- 


H 


<'-$ 


<-3 


H 


1 to 5 


7 


7 


4 


6 


17 


24 


6 to 11 


4 


1 


. . 


1 


2 


6 


12 to 17 


3 


1 


3 


2 


6 


9 


18 to 23 


6 


3 


1 


3 


7 


13 


24 to 35 


7 


1 


2 




3 


10 


Over 35 


1 










1 



TOTAL 28 13 10 12 35 63 



120 



A STUDY OF THE FEEBLEMINDED 



TABLE V— AVERAGE LENGTH OF TIME IN ONE JOB OF 63 OF THOSE 

NOW IN INDUSTRY, CLASSIFIED ACCORDING 

TO PERSONALITY 











>> 


>» 


Cffl 


>> 






83 

G 
O 
05 


"3 

a 
o 


■4-> 
g 

a 


«3 

a * 

o « 


2 
& 

a 


M 


CD 
09 


ft* 


O 

6 






o 

a 






X 


55 -e 


s 


w 


<% 


-sJ-O 


1 to 5 


8 


7 


4 


5 


16 


6 to 11 


8 


5 




3 


8 


12 to 17 


3 




5 


3 


8 


18 to 23 


2 


1 


1 


1 


3 


24 to 35 


6 






. m 




Over 35 


1 










TOTAL 


28 


13 


10 


12 


35 



Thirty-three individuals (more than half of the group) on whom informa- 
tion was secured have remained in their present place of employment from 
one to three years. These tables would indicate that those individuals with 
personality handicaps and character defects are liable to remain in a position 
only for short periods. The chances were two to one in favor of the individual 
without personality handicaps remaining in his job for six months, as com- 
pared to the individual with such handicaps. 

There is also some relationship between the degree of intelligence and the 
length of time in a particular job. For 38 individuals with I. Q.'s of 60 and 
above, the median time in the last job was 14 months; for 25 with I. Q.'s below 
60, the median time in the last job was 8.5 months. 

RACE AND SEX IN RELATION TO WAGE RECEIVED 

There are but nine negroes in this group who are now employed. It will 
be remembered that two are in factories, two work at odd jobs and five are 
employed as domestic servants. They receive wages varying from $6.00 to 
$16.00 a week. Two of the men have averaged $13.00 a week since leaving 
school. With one exception they all fall in the lowest two wage groups both for 
present earnings and for the average amount received. Five of the nine have 
averaged less than six months at one job, and six have been less than six 
months in their present jobs. The negroes who are now employed have the 
least satisfactory industrial records of any group studied. 

INDIVIDUALS WITH PREVIOUS INDUSTRIAL RECORD 

There are 20 individuals who are now at home but have previously been 
in industry — 15 of these are women and five are men; 15 are white and five 
are black; 11 are married (10 of the women and one of the men.) The reasons 
given for leaving the last place of employment are interesting — four of the men 
were "fired" and we have reports from the employers of "stupidity, lack of 
dependability, etc." — the other man was "laid off" and the employer states that 
when business is better he will take him on again. Four of the women stopped 
work when they were married, two others before the birth of the first child, 
one woman was "fired;" six left for various reasons, "needed at home," etc. 
Two colored girls have become prostitutes. 

WAGES RECEIVED 

The group is almost evenly divided between those who had only one, or 
at most two jobs and those who in the course of the two or three years since 




Number 




of Months 


Number 


1— 5 


14 


6—11 





12—17 




18—24 


1 



A STUDY OF THE FEEBLEMINDED 121 

leaving school have had two to fifteen jobs. A tabulation has been made 
therefore of either the one wage received or the median wage of a large 
number. A similar procedure has been followed in regard to length of time 
spent in one place of employment. 

TABLE VI— WAGE RECEIVED AND LENGTH OF TIME IN ONE JOB FOR 
THOSE PREVIOUSLY EMPLOYED BUT NOW AT HOME 

Amount 

Per Week 

$ 5 to $ 9 

10 to 14 

15 to 19 
Over $20 

TOTAL 20 20 

For but three individuals is there evidence of a fair degree of industrial 
success. One girl was earning $22.00 a week when she stopped work three 
months before the birth of her first child. She had worked in three tailor 
shops, always as the assistant to her mother who was paid $40.00 a week. 

The other individual who received more than $15.00 a week was a girl who 
had been excluded from school as a very low grade mental defective. She 
was employed at a meat packing house and had been receiving $19.00 a week 
for nearly a year. She stopped work when seven months pregnant. Though 
she had a low I. Q. (45) she had no outstanding personality difficulties and was 
apparently achieving a fair degree of industrial success. 

The one individual who remained longer than one year in one job was a 
boy who had been with an electrical supply house for two years. He began 
work at $1 a week when he was 15. He was receiving $9 two years later when 
he was laid off because of slack work. He also has a low I. Q. but suffers 
from no personality difficulties. 

SUMMARY OF THE GROUP NOW AT HOME 

The group as a whole is made up of industrially inefficient individuals. 
There are but two who do not give a history of serious personality or behavior 
difficulties. Eight of the fifteen women are sex delinquents. Three of the men 
and five of the women have been in correctional institutions. With one or two 
exceptions, the individuals who are now at home after a period of attempted 
employment present social problems. They have proved unproductive indus- 
trially. They contribute largely to the group of social misfits. 

INDIVIDUALS NOW AT HOME WHO NEVER WORKED 

There are four of the men and twenty-one of the women who have no 
industrial history. The men are without exception very low grade defectives. 
The women can be divided into two classes. About half have I. Q's of 50 or 
below. They have remained at home, usually helping with the work about the 
house. Of the others, many of them married within a year after leaving school. 

No one of the men gives a history of behavior difficulties. Three of the 
girls have had illegitimate children. Three others are sex delinquents. One 
has been arrested for shop lifting. Two were incorrigible before marriage. 

INSTITUTION CASES 

There are at present, eight individuals from this group who are in insti- 
tutions. Four are in the State Institution for the Feebleminded, in each case 
commitment was secured within one year after leaving school. Four are in 
correctional institutions. A history of them is given below. 

CASE 1. One boy, now 16, because of general incorrigibility was placed in the Boys' 
Opportunity Farm. He had three jobs in the two months between the close of school and 
the time he was sent to the institution. He never earned more than $8.00 a week. He has 
a feebleminded sister who is a sex delinquent and a sister who has been in two hospitals 



122 A STUDY OF THE FEEBLEMINDED , 

for the insane and is now a prostitute. The family has been handled by ten social agencies 
of Cincinnati. The boy has a mental age of eight and suffers from marked personality 
difficulties. 

CASE 2. A colored boy now 18 is at the Lancaster Industrial School. For five years 
he worked at "odd jobs," boot black, driver, and janitor. His last employer reported him 
to the Juvenile Court for stealing a car and wrecking it. The employer further stated that he 
was incorrigible and untrustworthy. Two brothers are now on official probation from the 
Juvenile Court. Although his mother is married to a colored man it is probable that at 
least two of the boys had a white father. 

CASE 3. A colored boy, now 19, has been sent to the Mansfield Reformatory. The 
charge against him was forgery. For three years after he left school he lived with his 
grandmother who apparently exercised to a remarkable degree, intelligent supervision over 
him. He worked steadily at fair wages, and there was no history of misconduct. After her 
death he would work a few weeks in one shop, quit, "rest" a week, and go to another. 
In less than a year he seems to have worked in very nearly every shop where printing was 
done. The end of the year found him in Mansfield. 

CASE 4. Grace, a white girl, now 21 has two institutional records. Before marriage at 
16 she had been sexually promiscuous, and when a son was born seven months after mar- 
riage, neither she nor her husband could state who the father was. When 19 she was sent 
to the Industrial School at Delaware. A year later when released she went to Texas. She 
admits frankly that she had sexual relations with several men while there and that money 
which she earned as a chocolate dipper went to the men she knew. When 20 she returned 
to Ohio and while visiting her brother in the northern part of the state she married without 
having received a divorce. One month later she was arrested for bigamy and in October, 
1921, was sent to the Reformatory at Marysville with an indeterminate sentence. Her mother 
has had five children all illegitimate and each child had a different father. The three sisters 
are all known to be immoral. 

HOME CONDITIONS 

The distribution of the values given the homes and neighborhoods from 
which these mental defectives come is as follows: 

TABLE 7— HOME AND NEIGHBORHOOD INDICES 



Index 


Home 


Neighborhood 


21—25 


7 


5 


17—20 


20 


20 


13—16 


29 


48 


9—12 


30 


21 


5— 8 


13 


12 


Unascertained 


22 


15 



TOTAL 121 121 

Twenty-seven cases live in homes which received a score of 17 and above, 
very favorable conditions for the children; 43 of these individuals came from 
homes grading less than 13, which indicates unfavorable condition surrounding 
the individuals living there; 13 persons came from homes receiving the very 
lowest rating possible. While fewer of the neighborhoods than of the homes 
from which these individuals come are in the highest group of indices, there 
are also fewer in the lowest group. Seventy-three individuals came from 
neighborhoods grading between 13 and 25 — indicating that the majority lived 
among fair conditions in regard to sanitation, recreation, social status of resi- 
dents, etc. 

CONTACT WITH SOCIAL AGENCIES 

Seventy-five per cent of these mental defectives come from families known 
to one or more of the social agencies of Cincinnati. Twenty per cent have 
had contact with more than four social agencies. Thirty-one families have 
had no contact with social agencies. Of the remaining 90 families, the average 
number of social agencies coming in contact with each family is three. 

Amongst these 121 individuals there were many so-called "maladjust- 
ments" to be found within the families from which they came. Such con- 
ditions as mental defect amongst other members of the family, epilepsy, psy- 
chopathic conditions, invalidism, alcoholism, delinquency, sexual irregularities, 
non-support on the part of the father, etc., were to be found. In the families 
of 21 individuals no such conditions were found. In the families of the remain- 



A STUDY OF THE F KEBLEMIXDF.n 123 

ing 100 individuals, the average number of such maladjustments was three and 
five-tenths. Of the total number of maladjustments noted, nearly one-third 
came under the head of mental defect. One-fourth of the maladjustments were 
evidences of delinquency — there were 18 mothers who were sex delinquents. 

COURT AND INSTITUTIONAL RECORDS 

Evidence of criminal conduct in this particular group has been carefully 
investigated. Our investigators made a careful search of court and institutional 
records, and went definitely into the question of delinquency in each case. As 
in our former study, we found no great evidence cf criminal conduct. Only 22 
persons out of this group of 121 have ever been in court or a delinquent insti- 
tution — four of these are now in correctional institutions. One interesting 
thing found here as in the other section of this study was that those individuals 
who had shown delinquent tendencies were all handicapped by psychopathic 
conditions and gave evidence of personality difficulties. All of this delinquent 
group came from families with one or more social maladjustments. The home 
indices for this delinquent group was much lower than that of the non-delin- 
quent. 

The following are illustrative cases of mental defectives who have made 
successful adjustments in life. 

W. — White; age 23; male; marital condition — single; Intelligence Quotient, 64; per- 
sonality make-up, no outstanding personality difficulties or character defects; physical con- 
dition, good; has a slight stammer. Maladjustments in family — father deserted family; 
brother is feebleminded. Home index, 15; neighborhood index, 17. 

Industrial History. Left school when 16, has been at same place of employment ever 
since. Began as an apprentice in a machine and tool making shop; earned $11 a week during 
his apprenticeship; for the last year has averaged $37.50 a week. Employer's report — "Good 
worker, honest, capable and ambitious. Received a $100 bonus when he completed his ap- 
prenticeship. This was received for efficient work. He is always prompt and neat." 

C. — White; age 22; marital condition — single; Intelligence Quotient, 65; personality 
make-up, no outstanding personality difficulties; physical condition, good; behavior difficul- 
ties and misconduct, none; one blind brother. The family has had contact with three social 
agencies, all dealing with health; home index, 19; neighborhood index, 17. 

Industrial History. Left school when 15. Has had three jobs, two of which have been 
in structural iron work. His present position, which he has held for three years, is that 
of a cutter in a shoe factory. He is at present earning $35 a week. Employer's report — 
"Energetic, ambitious worker. Is sociable and affable in the factory." 

B. — White; age 20; marital condition — single; personality make-up, no outstanding 
personality difficulties; physical condition, good; behavior, was in Juvenile Court once when 
ten years old for stealing. No further evidence of delinquent tendencies. Social agencies 
one (a free clinic); home index, 18; mother and sister have spells which resemble epilepsy. 

Industrial History. Has worked for five years in an electric supply house, first as an 
errand boy and now as a salesman. Present wage, $25 per week. Employer's report — "Has 
initiative and is careful, intelligent salesman. One of the best workers the firm has." 

Here we have a feebleminded boy who is really making a success in life, and yet, some 
one when he was ten years of age and arrested for stealing, and in the Juvenile Court, may 
have predicted because of his feeblemindedness, a serious criminal career. 

We will make no effort to present a long series of cases, but think that 
a few of the statements made by employers relative to the abilities of some 
of these mental defectives might be interesting. The type of work and the 
report of their present employer is given. 

FARM LABORER. — Employers statement — "Doing well. Honest and reliable; stupid but 

a fine worker." 

CHAUFFER.— Employer's statement— "Good, dependable worker." 

AUTO MECHANIC. — Employer's statement — "Fine worker. When I opened a shop of my 

own I took him with me from the place we had been working at together." 
MACHINIST. — Employer's statement — "Dependable, good steady worker." 
TRAVELING SALESMAN.— Employer's statement— "Hasn't much book knowledge, but 

can sell goods. Thoroughly dependable." 

ELECTRICAL WORKER.— Employer's statement— "Very good man. Capable, steady and 
ambitious." 

MACHINIST. — Employer's statement — "In charge of all machinery in our steam laundry. 
If some machine shops knew what a good worker he really is, they would snap him up. 
The only things he can't do are to read and figure." 

MACHINE HELPER.— Employer's statement— "Absolutely dependable but rather slow." 
FACTORY WORKER.— Employer's statement— "Splendid worker. Always on time. Ef- 
ficient and capable. In line for promotion, ambitious and has plenty of initiative," 



124 A STUDY OF THE FEEBLEMINDED 

FACTORY WORKER.— Employer's statement— "Childlike, quiet boy. Does his work 
well. Very steady." 

PRINTER. — Employer's statement — "Reliable and steady. Has seldom missed a day for 
four years." 

FACTORY WORKER.— Employer's statement— "Fast worker, steady— a regular utility 
man. Quick at picking things up." 

J. — Colored; age 23; Intelligence Quotient, 53; personality make-up, no outstanding per- 
sonality difficulties; physical condition, good; behavior, no history of any misconduct or 
delinquency; home index, 20; neighborhood index, 14; no maladjustment in the family. 

Career since leaving school. Began work immediately after leaving Special School for 
defectives; has held three jobs; has never been less than a year in a job, and has been in his 
last place of employment 22 months. He is a delivery errand boy for a firm of wholesale 
tailors. He receives $16 a week for this work. The employer's report is as follows — "Regular 
and obedient. He is not intelligent but always does what he is told and does it well." 

M. — White; age 30; female; Intelligence Quotient, 56; personality make-up, no out- 
standing difficulties of personality or character defects; physical condition, fair; home 
index, 18; neighborhood index, 25. 

Career since leaving school. Was a student at Special School for Defectives until after 
she was 20. Since that time she has remained at home taking care of her invalid mother. 
They have furnished housekeeping rooms and she does all of the work under the supervision 
of her mother. After the death of her father, 20 years ago, the mother undertook to carry 
on his real estate business, and though she is confined in a wheel chair all of the time, by 
using M. as a messenger, she has succeeded in maintaining herself and her defective daughter. 

J. — White; age 19; female; Intelligence Quotient, 64; personality make-up, no par- 
ticular handicaps, but slightly inadequate in make-up; physical condition, thin, restless, 
nervous type — in fair health; home index, 20; neighborhood index, 25. 

Career since leaving school. When she stopped school at 17 she was in the third grade. 
She is the youngest of nine children. One of the older sisters has devoted almost her entire 
time to J. After three years at home, she took a position as a filing clerk in a wholesale 
house. The older sister carefully supervised her work for a time, and at present she is 
getting along nicely and earning $15 a week. 

In order that we might refresh our minds as to the more common types 
reported in the usual investigations of feeblemindedness, we will record the 
following two eases, not because they were the worst, nor the best, but simply 
because they were the first two cases of unsuccessful careers that we came 
across. 

L. — White; age 19; male; marital condition — single: Intelligence Quotient, 45; person- 
ality make-up, egocentric, inconsiderate, unappreciative, difficult to get along with; physical 
condition, good; behavior, has been in court lor stealing; social agencies, six (three depen- 
dency, two delinquency, one health); home index, 13; neighborhood index, 15; mother and 
father divorced. 

Industrial History. Began work when 14, has had 12 jobs in five years and has averaged 
less than a month in any one of these positions. He is at present a "bus boy" earning $9 
a week. Some of his reasons for leaving former positions are as follows. "Didn't get sick 
benefit, so I left." "Discharged." "Got into a fight with the man over me." "Had a quarrel 
with the boss." Employer's report — "Disobedient and incompetent." 

B. — White; age 18; male; Intelligence Quotient, 64; shows very definite and outstanding 
personality difficulties and character defects; is in poor physical condition — is thin, nervous 
and restless — smokes incessantly; is known as a bum around the cheap dance halls of the 
district. Family has had contact with four social agencies (one dependency, two delinquency 
and one health). The father is alcoholic, a brother is alcoholic and has deserted his wife 
and child, the mother is feebleminded, a sister is feebleminded, and the mother and father 
are divorced. 

Industrial History. Began work when 15 years old. In the first year he had 16 jobs. He 
gives the following reasons for leaving positions: "Mother didn't want me to work there." 
"Not enough money." "Fired because sick one day." "Didn't pay enough." "Laid off." "Work 
slack." "Acid spoiled my clothes, so quit." "I didn't like the work." "Didn't like it. The 
work was too heavy." His present employer reports— "Getting careless. Will be discharged 
at the end of the month unless he does better work. His work is very easy and requires 
no intelligence." 

The above cases were not presented because they were particularly 
striking, but simply because they represented two very different types that 
must be reckoned with in any program for dealing with the feebleminded — 
"The good mental defective, and the bad mental defective." 

SUMMARY 

One hundred and twenty-one mental defectives diagnosed by the Cincin- 
nati Vocation Bureau during the years 1917 and 1919 were taken for this inves- 
tigation. They would now be between the ages of 16 and 22 years. The 



A STUDY OF THE FEEBLEMINDED 125 

reasons for their examination were principally requests of the Work Certi- 
ficate Office and the Placement Office, and school principals, for a diagnosis. 

The group is made up principally of native-born individuals of native-born 
parents. Seventy-eight and five-tenths per cent were white and 21.5 per cent 
were black; 46 were men and 75 were women; only 19 have been married (18 
women and one man.) 

Six and six-tenths per cent are in institutions (four persons in correctional 
institutions and four in the institution for the feebleminded.) Thirty-seven 
and two-tenths per cent are at home and not employed; 54.5 per cent are in 
industry; eight tenths per cent in the army and navy; eight-tenths per cent 
no information. 

Sixty-two per cent of the total number of cases were handicapped by some 
personality difficulty. One-half of those now in industry showed no evidence 
of personality difficulty or character defect; while two-thirds of those not 
employed showed such handicaps. 

A variety of occupations appears. Eight are salespeople, 33 are employed 
in factories, 12 are messengers, bell boys, etc., five are employed in housework, 
three are working for relatives, five are apprentices, printers, etc. 

Forty-eight of the 66 persons in industry are averaging from $10 to $22 per 
week in wages. 

Thirty-three individuals (half of the group) have remained in their present 
place of employment from one to three years. This study shows that those 
individuals with personality handicaps are liable to hold their positions only 
for short periods, while those without such handicaps, remain much longer. 

Twenty-seven individuals lived in homes scoring 17 or above, indicating 
very favorable conditions for the children; 43 of these individuals came from 
homes scoring less than 13, indicating unfavorable conditions surrounding the 
individuals living there; 13 came from homes receiving the very lowest rating 
possible. 

Seventy-five per cent of these mental defectives come from families that 
have had one or more contact with social agencies of Cincinnati; 20 per cent 
come from homes that have had contact with more than four social agencies. 

Criminal conduct was not very frequent amongst these 121 mental defec- 
tives, there being only 22 persons who had ever been in court or in a delin- 
quent institution. 

SUMMARY AND CONCLUSIONS 

The purpose of this investigation was to study the social adjustments and 
the industrial careers of an unselected group of mental defectives, in an attempt 
to discover wherein they had succeeded or failed, and what were the factors 
which caused their success or failure. Data touching on these points has now 
been presented for 177 ex-students of special classes for mental defectives, and 
121 mentally defective individuals who were examined at the Vocation Bureau 
and are now out in the community. 

The two groups overlap both in age distribution and in number of years 
out of school. The ex-students of special classes ranged in age from 18 to 30 
years; the 121 mental defectives examined at the Vocation Bureau ranged in 
age from 17 to 22 years. The individuals in the first group have been out of 
school from four to eight years; those in the second group have been out of 
school from one to six years. Both groups were unselected. None of them were 
chosen because they had become serious social problems. All of them were 
chosen for the one reason — that they gave evidence of mental defect. For the 
purpose, then, of a general summary, the data on the two groups may be 
combined. 

Two hundred and ninety-eight cases remained for study after the exclu- 
sion of 26 persons (reasons for which have already been given in the context 
of the report.) Of these 298 cases, 19 are in institutions for the feebleminded, 
four are serving sentences in correctional institutions, 142 are employed in 
industry, 11 are working for relatives, nine are in the army and navy, 71 are at 



126 . A STUDY OF THE FEEBLEMINDED 

home and have never worked, 41 are at home but have previous industrial 
records, and in the case of one there was no information obtained. 

Approximately half of the 298 cases are gainfully employed in industry, 
and are providing no particularly serious social problems for society (all of 
this without the exercise of any serious effort at supervision and aid by the 
community.) If this can be. said of an unselected group of feebleminded per- 
sons for whom society has not made especial provision in the way of industrial 
and vocational training, after-care and supervision, then what may we not 
accomplish under a purposeful plan and comprehensive program? 

These individuals were by no means limited to odd jobs and simple day 
labor in their occupations. There were 11 salesmen or salesladies, eight 
machinists, six construction workers (building trades), five printers and 
apprentices, 60 factory workers, 12 messengers and bell boys, 11 doing house- 
work for others, etc. 

Approximately half of those in industry were earning wages of $15 a 
week and more. We found in both studies that those individuals not handi- 
capped by personality difficulties and character defects, received much higher 
wages than those so handicapped. We found, also, that those who were out 
in industry were far less likely to be handicapped by character defects and 
personality difficulties than those who were unemployed. 

Approximately half of those individuals who were out in industry have 
remained in their present positions for longer than a year. We found quite a 
large group who had remained in their present jobs for two and three years. 
Here, as elsewhere, we found that the battle was in favor of those who were 
not handicapped by psychopathic conditions and personality difficulties. 

We made the statement that there has been an exaggeration concerning 
criminal tendencies of the feebleminded. Only 22.2 per cent of the first group, 
and 18.2 per cent of the second group have ever been in court or delinquent 
institutions. 

W r hile these individuals have not in many instances been delinquent, yet 
they come from families which have furnished many and varied social prob- 
lems to the community. Seventy per cent of the cases in the first group, and 
75 per cent of the cases in the second group come from families which have 
registrations with social agencies in Cincinnati. 

This study has led us to believe that mentally defective persons may 
be handled with success by other than institutional measures. We have been 
impressed with the fact that those elements that go to make for the failure 
or success of mental defectives in life are in no sense different from those 
elements that affect the lives of normal persons. Those same elements of 
character and personality make-up, those same conditions in the home, and 
those same factors in training that speak for the successful career of a normal 
child, bear with equal force on the career of the feebleminded child. 

In the light of this study, we are convinced that a large proportion of 
feebleminded persons can be handled economically and safely out in the 
community if properly trained and adequately supervised. With such training 
and supervision it is clear that feebleminded individuals who would otherwise 
become delinquents or dependents can be expected to develop into decent, 
self-supporting citizens and thus save the state millions of dollars for their 
maintenance. The keynote to the whole program is to be found in early 
recognition, adequate training, proper supervision, and in the case of those 
who are a menace — final segregation. Such a program would then contain the 
following points: 

A. Mental examination, by properly equipped persons, of all mentally 
defective children in the public schools. 

B. Special class training along manual, industrial and vocational lines 
of all mental defectives. 

G. After-care, kindly and friendly supervision of all mentally defective 
children in need of such. 



A STUDY OF THE FEEBLEMINDED 127 

D. Greatly increased institutional provision for those now in the com- 
munity who are a menace to the general public. 

E. The development of the colony system. A large proportion of the 
feebleminded can be usefully and profitably employed if intelli- 
gently directed. They can clear waste land, grub bushes, remove 
stones, build fences or roads, drive teams of horses or oxen, feed 
pigs, milk cows, take care of chickens, cultivate land and gather 
crops. They can excavate for buildings, haul stones, make bricks 
and cement blocks. The girls make splendid domestic servants 
and may be handled satisfactorily in colony groups according to 
the New York plan, originated by Dr. Bernstein. 

F. Adequate equipment of state institutions for the feebleminded, for 
the purposeful training of all feebleminded children who are capa- 
ble of profiting by such training. 

G. Provision for parole out into the community, under careful super- 
vision, of those mental defectives, who — after a period of pro- 
longed care and intensive training — have developed such desirable 
traits of character (industry, ambition, obedience, appreciation, etc.) 
as to render it likely that they can be handled with safety and 
profit out in the community . 



RECOMMENDATIONS FOR A STATE MENTAL 
HYGIENE PROGRAM 

(The following recommendations are offered as a basis for a comprehen- 
sive state program. These recommendations also include the state program 
which was prepared by Dr. Thomas Salmon, Medical Director of the National 
Committee for Mental Hygiene, in that phase of the Cleveland Hospital and 
Health Survey that dealt with mental diseases and mental deficiency.) 

1. State administration and supervision of the institutional care and treat- 
ment of persons with mental disease, mental deficiency and epilepsy, and 
of their guardianship in the community. Legislation is recommended that 
will accomplish the following objects: 

(a) Establishing a special Division of Mental Hygiene within the 
State Department of Public Welfare for the performance of the functions 
mentioned above. Such a division (headed by a physician experienced 
in dealing with the institutional and social aspects of mental disorders) 
to administer the State Hospitals for the Insane, the State Institution for 
the Feebleminded, the State Hospital for Epilepsy and the Bureau for 
Juvenile Research, and to concern itself with the broad medical and 
community relationships of these disorders, as well as with the business 
administration of the institutions. 

Such a division, aside from the administration of the above mentioned 
state institutions and the licensing and inspecting of private institutions for 
the care of mental patients, would have certain bureaus for the accomplish- 
ment of other very definite services. A Bureau of Clinics will organize 
"flying clinics" from state hospitals, Juvenile Research Bureau, and state 
institutions for the feebleminded, to serve public schools, juvenile courts 
and various communities of the state, while a Bureau of Social Service 
will have to do with the after care, parole and social service work in 
connection with paroled patients, and with the community supervision of 
mental defectives. 

2. Better institutional provision for the treatment of persons with mental 
diseases. 

(a) Providing adequate salaries for superintendents of state hospi- 
tals, assistant physicians, nurses, and occupational instructors, in order 
that more efficient treatment may be built up. 

(b) Providing clinical directors of psychiatry in all state hospitals, 
to be responsible for the scientific work and for the supervision of all 
training. 

(c) Providing training schools for nurses and attendants in all state 
hospitals, and a supervisor of nursing in the proposed State Division of 
Mental Hygiene, to supervise and standardize such instruction. 

(d) Instituting active after care and social service so that more 
patients may be paroled, and by following their supervision into the 
community, the durability of recoveries and remissions increased. 

(e) Instituting a system of mental clinics in the district of each state 
hospital for after care and preventive work, and in cities, co-operating with 
existing mental clinics, so that after care patients may be seen by the 
physicians who have them under their care while in state hospitals. 

(f) Providing stewards in state hospitals so that superintendents will 
be relieved from the administrative details that occupy a larger part of 
their time than supervising and developing medical activities. 

3. A comprehensive state program for dealing with the feebleminded and 
epileptic, to include: 

(a) A systematic mental examination of all children in the public 



A STATE MENTAL HYGIENE PROGRAM 129 

schools who are retarded three or more years. (Provision should be 
made for the routine accomplishment of this throughout the state.) In 
large cities clinical facilities can be developed in connection with exist- 
ing clinics and departments already maintained by schools and other 
agencies. In rural district "flying clinics" from state hospitals 
state institutions for the feebleminded and the Juvenile Research 
Bureau can supply the required physical and mental examinations. Some 
standardization of this work should be maintained and no child should be 
admitted to a special class until he has received the required physical and 
mental examination. All of this work, as far as the public schools of the 
state are concerned, should be done under the authorized supervision of a 
psychiatric advisor to the State Department of Education who may also be 
the chief of clinics in the Division of Mental Hygiene. It should be remem- 
bered that these school clinics should contain all of the facilities that 
psychiatrists, psychologists and psychiatric social workers can bring to 
bear upon the mental problems of school children — all of the resources of 
medicine and psychology instead of only those that deal with the measure- 
ment of intelligence. 

Another thing that should be borne in mind and that is that the scope 
of the study of the unadjusted school child should include other mental 
problems than mental deficiency. Above all, the aim of treatment should 
be made as prominent as diagnosis. 

The school clinic should be made use of by parents and teachers, for 
not only the mentally defective child, but the psychoneurotic child, 
the psychopathic child and those presenting conduct disorders. 

(b) Probably for generations to come the burden of training the 
majority of mental defectives will rest largely upon the shoulders of public 
school authorities, so that whatever training most defectives are to receive 
will be in the public schools. Every feebleminded child should receive 
special class instruction along such lines as will equip him for something 
useful in life. The training should be essentially industrial and vocational 
and not academic. Legislation making provision for special classes in 
every community in the state where there are ten or more such mentally 
defective children, and authorizing the payment by the State Department of 
Education, of a fixed sum — to the local school authorities — for each such 
class maintained, is recommended. The State Department of Education 
should maintain a state director or supervisor of such classes who should 
have charge of all special class work done in the state. This refers not 
only to the classes for defective children, but to those for retarded children, 
and those for the deaf and dumb, for the blind, the epileptic, and those 
suffering from speech disorders. 

(c) The most important phase of this entire program for dealing with 
the feebleminded, is that of state-wide supervision. There should be 
created within the Division of Mental Hygiene a Bureau that will have 
as one of the most important phases of its activities the supervision of 
the feebleminded in the community. To this Bureau could be committed 
delinquent and dependent feebleminded children graduating from special 
classes in the public schools, or those who are already out in the com- 
munity and need supervision; also this Bureau could be charged with the 
supervision of those well-trained defectives who are at the state institu- 
tion but are ready for parole out in the community. In this way it will 
be possible to continually make provision for beds at the state institution 
for the most urgent cases. We believe that the community supervision of 
the feebleminded is a phase of this program second to none in importance. 

(d) Increased institutional provision for the feebleminded and epil- 
eptic. 

Estimating the frequency of feeblemindedness on the basis of the 
army figures and the various state-wide surveys of this condition, con- 
ducted by the National Committee for Mental Hygiene, we would place 



A STATE MENTAL HYGIENE PROGRAM 



the total feebleminded populuation of this state between 25,000 and 40,000 
persons. At least one-third of these will need a period of institutional 
care, treatment and training. It is not believed that Ohio is doing more 
than touching the surface of the problem of mental deficiency in its pres- 
ent provisions for institutional care. It must be remembered that expense 
is no excuse. These persons are already an enormous expense to the 
general public, and their maintenance one way or another is being pro- 
vided for out of the public purse — though it may not appear in terms of a 
legislative budget. The colony system is becoming more and more popular 
throughout this country. We would recommend the development of 
colonies in connection with the state institution for the feebleminded. 

(e) Parole of well trained, carefully selected feebleminded persons 
out into the community. 

The success of this endeavor upon the part of certain institutions for 
the feebleminded has been so striking, that it is now generally agreed that 
this departure is changing the whole aspect of the institutional care of the 
feebleminded. A great many institutions are now paroling large numbers 
of well-trained mental defectives with success. This has made the old- 
time custodial institutions a thing of the past, and has caused institutional 
authorities to center their work upon intensive training along vocational 
lines. 

The above mentioned Bureau within the Division of Mental Hygiene 
of the State Department of Public Welfare should be charged with the 
supervision of these paroled cases. 

4. In the light of the importance that this and other studies has given to 
the mental condition of the offender, we would recommend legislation 
requiring a mental and physical examination of all inmates of state penal, 
correctional and delinquent institutions; repeated offenders in adult 
courts, and all problem children in juvenile courts. We believe that the 
most important step in the prevention of crime will be made when 
juvenile courts equip themselves with machinery for the careful study of 
all problem children that appear in court. 

5. Legislation is recommended that will accomplish the following objects 
in the way of improving commitment laws for the feebleminded and 
insane: 

(a) Provision for voluntary commitment of feebleminded children 
to institutions for the feebleminded. (In case the superintendent of such 
an institution finds that the return of the child to the community is 
unwise, he may have the regular court procedure of commitment insti- 
tuted.) 

(b) Parole of properly trained, carefully selected institutional cases 
to the community under the supervision of parole officers. (This parole 
should be for an indefinite period, depending upon the social adjustment 
of the individual, and not for any fixed time limit.) 

(c) Commiting mentally defective children and adults to guardian- 
ship and community supervision with provision for transfer from this 
form of commitment to institutions, and vice versa. 

(d) Commiting children and adults for observation for a period of 
ten days to state institutions for the feebleminded, state hospitals for epil- 
eptics, psychopathic hospitals, psychopathic wards in general hospitals, or 
the Bureau of Juvenile Research. 

(e) Eliminating the age of consent in mentally defective women and 
girls who have been committed to institutions or to guardianship and 
community supervision. 

(f) Authorizing sending nurses and attendants from state institutions 
for the feebleminded and state hospitals to bring from their homes or 
places of temporary detention, patients who have been committed and 



A STATE MENTAL HYGIENE PROGRAM 



are awaiting transfer — thus eliminating the services of sheriffs and police 
officers. 

(g) Authorizing counties to pay examining physicians, salaries 
instead of fees, for their services when mental examinations are made in 
psychopathic hospitals, psychiatric clinics, psychopathic wards in general 
hospitals or other mental clinics maintaining satisfactory standards. 

(h) Authorizing the proposed Division of Mental Hygiene of the State 
Department of Public Welfare to inspect places for the temporary deten- 
tion of mentally defective persons, and homes and schools in which 
delinquent or dependent children are maintained. 

(i) Removing present restrictions as to number of volunteer patients 
that can be received in state hospitals. 

(j) Committing patients for observation for a period of ten days to 
state hospitals, psychopathic hospitals and psychopathic wards in general 
hospitals. 

(k) Prohibiting the detention of persons awaiting commitment in jails 
or almshouses and placing the responsibility for their care pending com- 
mitment and reception in state hospitals in the hands of health officers, 
except in cities where suitable facilities are otherwise provided. 

(1) Discontinuing the personal appearance of mental patients in 
court. 

(m) Admitting patients to state hospitals in emergencies upon the 
certificate of two physicians, such admissions to be followed within ten 
days by discharge or court commitments. 

(n) Committing to state hospitals any persons under trial in whom 
mental disease is suspected upon order of any trial judge, such commit- 
ments being for observation only and for a period not less than ten nor 
more than thirty days. 

Mental Hygiene Committee. 

The newly organized Committee for Mental Hygiene should receive 
the support of all those who desire to see the state assume the duties that 
rightfully belong to it so that local agencies need not continue devoting a 
large part of their resources to the performance of tasks that arise chiefly 
from the state's negligence. Not until the state has met its obligation to 
provide for the mentally defective and epileptic will the local agencies — 
both public and private — be able to devote themselves exclusively to the 
work for which they were created and are maintained by public funds or 
private philanthropy. A strong State Committee for Mental Hygiene, with 
definite objects and strongly supported by public spirited citizens, can do 
more to accomplish these ends than any other type of private agency. 



INDEX 



Associated Charities, 8, 52-53, 57; 
relief cases, 8, 52-53; unemployment 
cases, 8, 53; summary, 57. 

Avondale School, 69, 71. 

Beckman Dispensary, 50. 

Behavior: of adult dependency cases, 
46, 50, 53, 55; 50 dependent Jewish 
families, 50; Hamilton County Jail 
cases, 36; of Juvenile Court cases, 
13; of juvenile dependency cases, 43; 
of 201 ex-students of classes for 
mental defectives, 112. See also 
Conduct Disorders. 

Blind Classes, 85-86. 

Board of Education : financing of Voca- 
tion Bureau by, 92. 

Boarding Homes, 42, 43. 

Boys' Opportunity Farm, 30-31, 38; 
classes conducted by Board of Edu- 
cation at, 85 ; general analysis of 
data gathered for Survey, 30-31 
Mental Diagnosis (Table) 31 ; phy 
sical condition of inmates, 31 
School Retardation (Table) 30 
summary, 38. 

Boys' Special School, 85, 89. 

Bureau of Catholic Charities : adult 
dependency, 8, 45-46; 56-57; juvenile 
dependency, 8, 42, 43. 

Catherine Booth Home: See Unmar- 
ried Mothers. 

Central Psychiatric Clinic: See Psy- 
chiatric Clinic. 

Children's Home, 8, 41-42, 43 

City Infirmary, 8, 53-54, 55-56, 58; 
buildings, 54; food, 54; medical at- 
tention, 54; summary, 54, 58. 

Classes, special : See Special Classes in 
Public Schools. 

Clinical Facilities for Examination 
of Mental Cases: See Mental 
Cases, Clinical Facilities for Exam- 
ination of. 

College of Medicine, Out-Patient Dis- 
pensary, Neurological Clinic of: 
See Neurological Clinic, Out-Pa^ 
tient Dispensary. 



Community Chest: financing of Voca- 
tion Bureau by, 92. 

Conduct Disorders : Juvenile Court 
cases, 25; juvenile dependency cases, 
43; in Public School children, 8, 67, 
81, 89. See also Behavior. 

Confidential Exchange: clearing of 
cases with, 25, 71, 115. 

Conservation of Vision Classes, 85-86. 

Convalescent Home, 50-51. 

County Infirmary: See Hamilton 
County Home. 

County Jail : See Hamilton County Jail. 

Court of Domestic Relations: juve- 
nile division ; See Juvenile Court. 

Courts : need for adequate mental clinic 
in, 11; recommendations for, 40-41, 
102; records of feebleminded in, 114, 
123-24. 

Crippled Children : school for, 87. 

Deaf: classes for, 86. 

Defective Teeth: See Physical Condi- 
tion. 

Defects, Physical: See Physical Con- 
dition. 

Delinquency, 7-8, 10-41 ; contact of So- 
cial Agencies with, 24-25. 

Delinquency, Adult, 7, 31-39. See also 
Hamilton County Jail; Ohio Humane 
Society. 

Delinquency, Juvenile, 7, 11-31. See 
also Boys' Opportunity Farm; Girl's 
Opportunity Farm; Juvenile Court. 

Delinquents : classes for, 85 ; typical 
psychopathic, 29-30. 

Dependency, 8, 41-58. 

Dependency, Adult, 8, 45-58 ; Associated 
Charities, 122 relief cases, 8, 52-53 ; 
Associated Charities, 100 unemploy- 
ment cases, 8, 53 ; Bureau of Cath- 
olic Charities, 45-47; City Infirmary, 
53-54; fifty dependent Jewish fami- 
lies, 46-52; Hamilton County Home, 
54-56; summary, 55, 56-58. 

Dependency, Juvenile, 41-44; Mental 
Diagnosis (Table), 42; physical con- 
dition, 44; summary, 56; See also 
Children's Home; Bureau of Catho- 
lic Charities; Boarding Homes, 
General Protestant Orphanage. 



INDEX 



Employment Certificate Office of 
Public Schools: See Vocation Bu- 



Employment of Feebleminded, 111-13, 
118-21, 125, 126. 

Endocrine Disorders : per cent of Asso- 
ciated Charities dependency cases 
suffering from, 52, 53, 57; evidenced 
in Juvenile Court cases, 18; in Pub- 
lic School children, 8, 69 ; in study of 
50 dependent Jewish families, 48. 

Environment: Juvenile Court cases, 18; 
problem school children, 71. 

Epileptic Children : additional provi- 
sion recommended for, 102 ; Juvenile 
Court cases, 7 ; in Public Schools, 8, 
64-66, 79-80; supervision of, 102. 

Feebleminded: in public school, 8, 10, 
81-82; home index of, 21; Juvenile 
Court cases, 7, 21 ; per cent found 
among adult dependency cases, 45, 
52, 53 ; Boys' Opportunity Farm, 7 ; 
Girls' Opportunity Farm, 7 ; group 
of unmarried mothers, 7-8, 37 ; Ham- 
ilton County Home, 8; Ohio Hu- 
mane Society, 7 ; Study of careers 
of 322 feebleminded persons, 107-27 ; 
supervision of, 129-30; supervision of 
in industry, 93, 126-27. 

Foreigners : classes for, 87 ; dependency 
cases among, 56-58. 

Foreign-born : classes for, See Foreign- 
ers, Classes For. 

Fresh Air Schools: See Open Air 
Classes. 

General Protestant Orphanage, 42, 43. 

Girls' Opportunity Farm, 7, 27-39, 37- 
38; analysis of material gathered in 
Survey, 27-30; classes conducted by 
Board of Education at, 85; Mental 
Ages of Girls Classified According 
to Chronological Age (Table), 27; 
Mental Diagnosis (Table), 28; Per- 
sonality Types (Table), 28; physi- 
cal conditions, 28-29; School Retard- 
ation (Table), 28; summary, 37-38. 

Guardianship: Juvenile Court cases, 
18-19; Public School children, 71. 

Hamilton County Home, 8, 54-56, 58; 
summary, 58. 

Hamilton County Jail, 7, 34-36; 38-39; 
analysis of material gathered, 34-36; 
Offenses (Table) 35 ; mental diagno- 
sis, 36; physical condition, 36; sum- 
mary, 38-39. 



Handicapped Children : school for. See 
Crippled Children, school for. 

Home Conditions : See Home Index. 

Home for the Friendless : See Unmar- 
ried Mothers. 

Home Index, 21-23, 80-81 ; analysis of 
for mental defectives, 74, 76-77 ; an- 
alysis of for psychopathic children, 
75-76 ; of Juvenile Court cases in re- 
lation to delinquency, 21-23, 26; 201 
ex-students of special classes for 
defectives, 114-15; 121 diagnosed as 
feebleminded, 122; Public School 
children, 70-71, 72-73, 74-77, 80. 

Home Visiting : by Vocation Bureau, 95. 

Humane Society: See Ohio Humane 
Society. 

Illegitimacy: among feebleminded, 109; 
See also Unmarried Mothers. 

Industrial Classes : at Girls' Oppor- 
tunity Farm, 27 ; See also Pre-voca- 
tional Classes. 

Industrial History: See Employment. 

Intelligence Quotients : See Intelli- 
gence Rating. 

Intelligence Rating: adult dependency 
cases, 45, 45-49, 52, 53, 56, 57 ; Juve- 
nile Court cases, 7, 13-14, 17, 25. 

Jewish Families, 50 Dependent: 46-52, 
57; Ages (Table), 46; dependency, 
extent of, 47, 50-51 ; Marital Condi- 
tions (Table), 47; Mental Diagnosis 
(Table) ; 47; physical conditions, 48 ; 
relative ages of husbands and wives, 
48; summary, 57. 

Jewish Foster Home, 50. 

Judges : need for knowledge of mental 
hygiene, 104. 

Juvenile Court, 7, 11-27; analysis of 
material gathered for Survey, 12-25 ; 
Behavior History (Table) 13; 
Chronological Ages of Children Upon 
Leaving School (Table), 12; clinical 
facilities of court, 12; contact with 
Social Agencies, 24-25 ; co-operation 
with Vocation Bureau, 12, 95 ; delin- 
quency, 7, 11-27; guardianship of 
child, 18 ; home conditions of girl de- 
linquents, 22; home index, 21-23 ; in- 
telligence rating, 13-14; jurisdiction, 
11 ; Mental Ages of Children Classi- 
fied According to Chronological Age 
(Table), 14; mental diagnosis, 15; 
mental diagnosis and race, 15 ; men- 
tal diagnosis and frequency of of- 
fense, 16; mental diagnosis and sex, 



INDEX 



Juvenile Court (continued) 

15; neigborhood index, 23-24; neu- 
rological clinic, co-operation with, 
12 ; only child, 19-20 ; personality 
make-up, 16 ; physical condition, 16- 
17 ; qualification of ' probation 
officers, 12; School Retardation (Ta- 
ble), 13; social maladjustments in 
the family, 20; social environment, 
18, staff, 11; summary of findings, 
25-27; truancy, 19; vagrancy, 19. 

Law School Students : need for train- 
ing in mental hygiene, 104. 

Malnutrition: See Physical Condition. 

Medical Students : need for training in 
psychiatry, 101. 

Mental Cases : Clinical Facilities for 
Examination of : 90-101 ; neurologi- 
cal clinic, Out-Patient Dispensary, 
90, 98 ; neuro-psychiatric clinic at 
United Jewish Social Agencies, 90, 
98 ; Psychopathic Institute of United 
Jewish Social Agencies, 96-98 ; Vo- 
cation Bureau, 90, 91-96. 

Mental Defectives, 63-64; analysis of 
home index, 74, 76-77 ; classes for, 
82-83; in public schools, 8, 63, 64; 
need for supervising of, 102 ; study 
of careers of 322 feebleminded, 107- 
27 ; study of careers of 121 diagnosed 
as feebleminded by Vocation Bureau 
in 1917-1919, 117-27; study of ca- 
reers of 201 ex-students of special 
classes, 107-17. See also Feeble- 
minded. 

Mental Diagnosis : adult dependency 
cases, 47, 48-49, 52, 53, 56; Boys' 
Opportunity Farm cases, 31 ; Girls' 
Opportunity Farm cases, 28 ; Hamil- 
ton County Jail inmates, 36 ; Juvenile 
Court cases, 15-16; juvenile depend- 
. ency cases, 42 ; Ohio Humane So- 
ciety cases, 32; Public School Chil- 
dren, 59, 62; unmarried mothers, 37. 

Mental Hygiene : need for organization 
to carry out community program for, 
102-03, 131 ; recommendation for 
state program, 128-31. 

Mental Hygiene Survey : conclusions, 
98-101; methods, 9-10; recommenda- 
tions from, 101-103; scope of, 9. 

Neighborhood Index : 80-81 ; Juvenile 
Court cases, 23-24; 26, 27; 121 diag- 
nosed as feebleminded, 115, 122; 
Public School children, 70-71 ; 73-74, 
77-79, 80; 201 ex-students of classes 
for mental defectives, 115. 



Neurological Clinic, Out-PatiEnt Dis- 
pensary, 90, 98; organization, 98; 
plan and scope of work, 98. 

Neuro-Psychiatric Clinic: at United 
Jewish Social Agencies, 90, 98. 

Observation Classes, 83-84. 

Ohio Humane Society: 7, 31-34, 38; 
analysis of data gathered, 32-34 ; 
illustrative cases, 33-34; Mental 
Diagnosis (Table), 32; staff, 32; 
summary, 38; Types of Cases (Ta- 
ble), 32. See also Unmarried 
Mothers. 

Open Air Classes, 86-87. 

Opportunity Classes, 84. 

Opportunity Farms : See Boys' Oppor- 
tunity Farm and Girls' Opportunity 
Farm. 

Oral Classes, 86. 

Oral School, 86. 

Out-Patifnt Dispensary, Neurologi- 
cal Clinic of: See Neurological 
Clinic, Out-Patient Dispensary. 

Parental Conditions : See Home Index. 

Parental Supervision: See Home In- 
dex. 

PeasleE Oral School : See Oral School. 

Personality Difficulties : See Per- 
sonality Make-Up. 

Personality MakE-Up, 10; in adult de- 
pendency cases, 45-46, 50, 52-53; of 
feebleminded, 125 ; Girls' Opportun- 
ity Farm cases, 28; Hamilton Coun- 
ty Jail, 26; Juvenile Court cases, 16; 
in juvenile dependency cases, 43-44; 
of problem Public School children, 
66-67. 

Physical Condition : adult dependency 
cases, 45, 46, 48, 52, 53, 55, 56, 57 
Boys' Opportunity Farm cases, 31 
Girls' Opportunity Farm cases, 28-29 
Hamilton County Jail inmates, 36 
Juvenile Court cases, 16-18, 26; juve- 
nile dependency cases, 44, 56 ; Ohio 
Humane Society cases, 33; physical 
examination at Juvenile Court, 12; 
Public School children, 67-69, 81. 

Placement Office of Public Schools : 
See Vocation Bureau. 

Pre- Vocational Classes, 84. See also 
Industrial Classes. 

Psychiatric Clinic: need for, 41, 90, 
96, 101, 103. 



INDEX 



Psychiatric Clinic: training and duties 
of director of, 101, 103, 104. 

Psychiatric Examinations: need for 
in adult dependency cases, 45 ; num- 
ber given at Juvenile Court, 12; of 
Vocation Bureau, 94-95 ; results of 
in 50 dependent Jewish families, 49. 

Psychiatric Social Work : recommen- 
dation for school of, in University, 
103. 

Psychological Laboratory of Public 
Schools: See Vocation Bureau. 

Psychoneuroses : adult dependency 
cases, 45; Associated Charities cases, 
52; in 50 dependent Jewish families, 
50, 51. 

Psychopathic Adults : 50 dependent 
Jewish families, 50, 51 ; Associated 
Charities cases, 52, 53. 

Psychopathic Children, 63 ; analysis of 
home index of, 75-76; home condi- 
tions of, 19; in juvenile dependency 
cases, 43 ; Juvenile Court cases, 7 ; in 
Public Schools, 8, 81-82; relation to 
small families, 19-20 ; supervision of, 
102. See also Delinquent, Typcial 
Psychopathic. 

Psychopathic Institute oe United 
Jewish Social Agencies, 90, 96-98; 
cases, classification of, 97; cases, 
number and source, 97; examina- 
tions, 97 ; organization, 96 ; plans 
and scope of work, 97 ; source of 
finances, 90; summary, 97-98. 

Public School Children, 8, 58-90; an- 
alysis of data gatered, 59-89; Avon- 
dale School, 69-71 ; Chronological 
Age Classified According to Grade 
Attained in School (Table), 60; 
Chronological Age Classified with 
Reference to Test Age (Table), 61; 
comparative statistics in two schools, 
69 ; conduct disorders, 67 ; epileptic 
child, 64, 66, 79-81 ; Grades Repeated, 
Classified with Reference to Mental 
Diagnosis (Table), 59; guardianship, 
71; home index, 70-71, 72-73, 74-77, 
80; mental conditions, 62-66; men- 
tally defective child, 63-64, 76-77; 
Mental Diagnosis (Table) 62; Men- 
tal Retardation and Advancement 
(Table) 61 ; neighborhood index, 70- 
71, 73-74, 77-79, 80; nervous and 
psychopathic child, 63 ; personality 
difficulties classified according to 
mental diagnosis, 66-67 ; physical 
condition of, 67-69, 81 ; problem 



Public School Children {continued) 
school child, 70-81, 82; Retardation 
and Advancement with Reference to 
Grade Attained (Table), 60; retard- 
ed child, 62; special classes, 82-89 
speech defect, 66 ; Speech Disorders, 
Classified with Reference to Mental 
Diagnosis (Table) 65; study of 201 
ex-students of special classes for 
mental defectives, 107-08, 108-17; 
study of 121 mental defectives, diag- 
nosed as feebleminded by Vocation 
Bureau, 117-27; summary, 81-82. See 
also Vocation Bureau. 

Recidivism : See Repeated Offenders. 

Recreation : in relation to delinquency, 
See Neighborhood Index. 

Repeated Offenders, 40; Hamilton 
County Home, 55 ; Hamilton County 
Jail, 36; in Juvenile Court, 12. 

Retardation: adult dependency cases, 
48-49, 52, 53, 55, 57; Boys' Oppor- 
tunity Farm cases, 30; Girls' Oppor- 
tunity Farm cases, 28; Hamilton 
County Jail cases, 36; Juvenile 
Court cases, 12-13, 25 ; juvenile de- 
pendency cases, 42, 56; unmarried 
mothers, 37; Public School children, 
60-61, 62-63; 201 ex-students of 
classes for mental defectives, 112. 

Retarded Child : See Retardation, Pub- 
lic School Children. 

Scholarships : See Vocation Bureau. 

School Attendance: See Vocation Bu- 
reau. 

School Census : See Vocation Bureau. 

School Retardation : See Retardation, 
Public School Children. 

Social Agencies : contact of juvenile de- 
linquents with, 24-25 ; dependents 
with, 24-25; feebleminded with, 115- 
17, 122; problem school children 
with, 70. 

Social Environment: See Environment. 

Social Investigations : See Home In- 
dex. 

Social Maladjustments: of Juvenile 
Court cases, 20; Public School 
children, 70. 

Somatic Disease: See Physical Condi- 
tion. 

Special Classes in Public Schools, 
82-89, 90; at Boys' Opportunity 
Farm, 30; at Girls' Opportunity 
Farm, 27; conservation of vision and 
blind classes, 85-86 ; crippled chil- 
dren, 87; for foreigners, 87; for 



INDEX 



Special Classes in Public School 
(continued) 

mental defectives, 82-83 ; observa- 
tion classes, 83-84; open air classes, 
86-87; opportunity classes, 84; oral 
classes, 86; pre-vocation or indus- 
trial classes, 84 ; recommendation for 
extension of facilities of, 102; 
schools for delinquents, 27, 30, 85. 

Speech Defect, 65-66; classes for cor- 
rection of, 86. 

Teachers : need for training in mental 
hygiene, 103. 

Truancy, 19. 

United Jewish Social Agencies: de- 
pendency, 8 ; neuro-psychiatric clinic, 
98; Psychopathic Institute, 96-98. 
See also Beckman Dispensary; Con- 
valescent Home; Jewish Families, 50 
dependent; Jewish Foster Home. 

University oe Cincinnati, College of 
Medicine: neurological clinic of. See 
Neurological Clinic, Out-Patient Dis- 
pensary. 



Unmarried Mothers, 7-8, 36-37, 39; an- 
alysis of material gathered, 37 ; men- 
tal diagnosis, 37; summary, 39. 

Vagrancy, 19. 

Vision, classes for conservation of, 85- 
86. 

Vocation Bureau, 12, 91-96; budget, 92 
employment certificate office, 92 
home visiting, 95; history, 91-92 
Juvenile Court, co-operation with 
12, 95; medical examinations, 94 
placement office, 92-93; psychiatric 
examinations, 94-95 ; psychological 
laboratory, 93-94 ; recommendation 
for extension of, 102; scholarships, 
95 ; school attendance, 95-^6 ; school 
census, 95-96 ; source of finances, 92 ; 
study of 121 diagnosed as feeble- 
minded by, 117-27; summary, 96; 
supervision of feebleminded in in- 
dustry, 92. 

Washington School, 69, 71. 




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